The “hub” of the system, is the National Health Insurance Fund (NHIF) which is administered by the National Health Insurance Authority (NHIA). The “satellites” are a country wide network of CBHI schemes known as District Wide Mutual Health Insurance (DWMHI) schemes which are monitored, subsidized and re-insured by the “hub.”
The NHIS is interesting in that it has adapted the Social Health Insurance (SHI) model so that informal workers can be included into the scheme. By combining a network of CBHI schemes with a centralized authority and source of funds (the SHI component) to ensure nationwide coverage and to guarantee the financial sustainability of the schemes, the NHIS has attempted to adapt the best aspects of these two very different health financing models to fit the particular socio-economic landscape of Ghana.
The NHIF is financed from several different sources. These include:
- A 2.5% health insurance levy added to VAT
- Formal sector contributions
- Member premiums of between 7.20 to 48.00 Ghana cedis annually (USD5.00 – USD34.00)
- Investments made by the NHIC
(a)Funds allocated to the scheme by the Government of Ghana
(b)The central exemptions fund, formerly used to provide exemptions from user fees for those classed as ‘indigent’
The health services covered by the NHIS are laid out in the minimum basic benefits package. The basic benefits package is fairly extensive and purports to cover 95% of all health problems reported in Ghanaian health care facilities, though there is a noticeable emphasis on female reproductive health. Expensive, highly specialized care such as dialysis and organ transplants are not covered by the NHIS. ARVs for the treatment of HIV/AIDS are also not covered as these drugs are supplied by a separate government program.
In order to provide the basic package of services, the NHIS covers both public and private health care providers at all levels of the health system, subject to their accreditation by the NHIA.