National Health Insurance Case Study

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CHALLENGES IN NATIONAL HEALTH INSURANCE SCHEME
The National Health Insurance Scheme(NHIS) is simply a social intervention program, introduced by the government of Ghana to eradicate the financial burden that comes with accessing quality health care services in Ghana. As a matter of fact, quality health care is expensive. Therefore, the introduction of the NHIS in Ghana seeks to underestimate this fact to some extent. The NHIS is funded by The National Health Insurance Levy(NHIL), which is 2.5% levy on goods and services collected under the Value Added Tax, 2.5% points of Social Security and National Insurance Trust (SSNIT) contributions monthly, return on National Health Insurance Fund (NHIF) investments, premium paid by informal sector subscribers
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There are three main payment systems that are been used in the NHIS; the itemized fee for service payment system, the diagnoses related grouping system and the capitation system. The itemized fee for service payment system involves the service providers providing the NHIA with a ‘list’ of the various services rendered to the subscribers. The diagnoses related grouping (DRG) method requires service providers to be paid based on the diagnoses of the subscribers. In the newer capitation system, the service providers are prepaid based on the number of subscribers that have chosen that particular service provider as their primary service provider. Despite using a combination of these three methods in ensuring successful reimbursements, some service providers complain that they receive their reimbursements in a highly untimely manner and sometimes there could be a very long delay in receiving their payments. This has led to the service providers denying subscribers access to cheap and quality health care and granting non-subscribers access to quality health care services because they are willing to pay the prices. This challenge has been attributed by many to be as a result of the manual nature of processing of claims of the service providers. Under the current system, service providers present the NHIA with…show more content…
The scheme since its inception has recorded increasing numbers of members and as time goes on more and more people will come on board. However, the goal of making quality health care affordable to everybody has since not been met adequately yet. The target for the poor especially has not been met yet. Most of the subscribers on the scheme currently, are better educated richer Ghanaians who understand the schemes offer and avail themselves for it. The many illiterate rural Ghanaians find the process daunting, especially the bureaucracy of the system. The registration centres are also often too far away from their villages and the cost of registration which is around GH₵ 24 still remains a little too expensive for them. These registration centres for the NHIS always require constant electricity in order to sign subscribers up on the scheme, because they utilize computers and other electrical machines such as the biometric device to upload details of subscribers on the NHIS database. In view of this, registration centres are situated in well to do areas and not the remote ones. These areas, as previously stated are mostly far from the indigents, making it difficult for them to sign up too. So it can be said, that the NHIS really has not been able to serve its purpose but just to favour a few average Ghanaians and not the indigents

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