NHIS [recap]

Question 1

Insurance

Answer 1

Insurance
An arrangement with a company or an institution in which regular amounts of money are paid so that the company/institution pays the cost of some service as and when needed.
•It is a security
•It serves as a guarantor for bank loans
Examples of Insurance coverage:
•Death,
•Ilness,
•Loss of a material (car, building, ship, shop, factory etc) through accident, theft or fire.

Question 2

BASIC DEFINITIONS IN INSURANCE:
Premium
Solidarity
Morale hazard

Answer 2

BASIC DEFINITIONS IN INSURANCE:
Premium:
•The regular contributions paid by the clients towards the scheme.

Solidarity:
•The strength of a scheme is based on the number of contributors. The larger the number of contributors the stronger the scheme. “Consider the Broom”.
•There is risk sharing and risk equalization

Morale Hazard:
• Providers continue to prescribe more drugs and expensive diagnostics. And clients also abuse the system by accessing health care even when they could avoid visits to health facilities.

Benefit Package:
•Minimum services that members can receive.

Question 3

DESIGN OF A BASIC HEALTH
INSURANCE SCHEME:

Answer 3

DESIGN OF A BASIC HEALTH
INSURANCE SCHEME:
Also referred to as the pillars are:-
•Scheme administration
•Clients of the Scheme
•Providers of health services to the Scheme

Question 4

Modes of payment

Answer 4

Modes of payment

1. Fee for service:
   • payment to a provider is based on each service rendered.
   •Ensures high quality service to clients since providers will undertake all services required by the patient without worry
   •It is subject to abuse by providers through request of sometimes unnecessary tests. This could raise the cost of insurance payment if a proper costing system and monitoring is not adopted due to the excessive drug prescriptions and diagnostics.
2. Co-payment
   •The client is made to pay a certain amount of money any time he/she receives a service. The amount he/she pays is a proportion of the actual cost of services.
   •It helps checks abuse of services as the client always has to pay some part of the medical bill
   •It can affect access to health care by the insured because of the payment demanded.
3. Capitation
   •an agreement on the payment of a fixed amount of money to providers irrespective of whether services have been rendered or not
   •May be cheaper for the management unit since providers do not charge per service.
   •Quality of service may be compromised when funds approved by scheme do not meet the cost of services rendered by providers.
4. Diagnostic related grouping (DRG)
   •an agreement on the payment of a fixed amount of money to providers based on diagnosis related groupings. Eg. OPD, PAED 36C, MED 128A, ZOOM, OBGY06A
   •May be cheaper for the management unit since providers do not charge per service but based on diagnosis.
   •Quality of service may be compromised when funds approved by scheme do not meet the cost of services rendered by providers.

Question 5

History of individual health care

Answer 5

History of individual health care
•From the late 1950s up to 1966, when the Convention Peoples’ Party government was overthrown, healthcare financing in Ghana was virtually free.
•Ghanaians were asked to pay for their healthcare during subsequent regimes. Drugs and consumables were highly subsidized.
•In the 1980’s the poor economic situation of the country led to low staff morale and poor hospital attendance.
Cash and Carry’ the system of healthcare financing introduced by the PNDC survived until 2004 when the present health insurance system came into being.
•Under Cash and Carry’, patients were required to pay for drugs and some medical consumables while the state bore all other costs including consultation, salaries and emoluments of health workers in state hospitals.
•Experimentation of various insurance schemes-CHAG (Nkoranza, Techiman schemes) and private schemes like nationwide mutual, Medex etc acted as precursors

The New Patriotic Party (NPP) enacted, the National Health Insurance Act 650 in 2003, which led to the establishment of a National Health Insurance Scheme(NHIS) in 2004 under a National Health Insurance Authority(NHIA).

•Funding for the NHIS are from two main sources:- the NHI Levy, a 2.5% top up of the Value Added Tax (VAT), and a 2.5% transfer from the existing Social Security and National Insurance Trust. For those not on SSNIT, paying an annual premium.