Table 4 Summary of challenges to financial sustainability in NHIS
From: Something old or something new? Social health insurance in Ghana
Dimension | Current challenges |
|---|---|
Funding sources | Majority of income grows with growth in consumption, not with membership. Very low premia for informal sector in relation to cost of care. |
Benefits package | Benefits package comprises an estimated 95% of all treatments in Ghana, with no limit to consumption. |
Coverage | Large proportion of population is exempt and these categories continue to grow Membership is growing and with a growing rate of utilisation by members |
Payment systems | Prices have risen with new DRG payment system Drug costs additional – incentive to over-prescribe Anecdotal evidence of 'tariff creep' and gaming by providers Reported increase in fraudulent claims Increasing role of private sector (increases access but also raises costs) |
Cost-control | No co-payments Gate-keeping not effective – patients self-refer to secondary hospitals and tertiary ones use their polyclinics as an entry point into specialist care |
Monitoring | Poor monitoring and control systems within the NHIS, although a new IT system is being introduced which may improve the situation |