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Ghana National Health Insurance Scheme

Author : Huihui Wang

Publisher : World Bank Publications

Page : 101 pages

File Size : 31,41 MB

Release : 2017-08-14

Category : Business & Economics

ISBN : 1464811180

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Book Description

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.



Ghana National Health Insurance Scheme

Author : Huihui Wang

Publisher : World Bank Studies

Page : 68 pages

File Size : 43,5 MB

Release : 2017-07

Category : Business & Economics

ISBN : 9781464811173

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Book Description

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country's commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers' abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.



Health Financing in Ghana

Author : George Schieber

Publisher : World Bank Publications

Page : 196 pages

File Size : 23,12 MB

Release : 2012-08-30

Category : Medical

ISBN : 082139567X

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Book Description

This volume analyzes Ghana s National Health Insurance Scheme and highlights the range of policy options needed to assure its financially sustainable transition to universal coverage.



The Impact of Health Insurance in Low- and Middle-Income Countries

Author : Maria-Luisa Escobar

Publisher : Rowman & Littlefield

Page : 239 pages

File Size : 39,27 MB

Release : 2011-01-01

Category : Political Science

ISBN : 0815705611

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Book Description

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.



Health Reforms Across The World: The Experience Of Twelve Small And Medium-sized Nations With Changing Their Healthcare Systems

Author : Kieke G Okma

Publisher : World Scientific

Page : 392 pages

File Size : 43,86 MB

Release : 2020-02-24

Category : Medical

ISBN : 981120893X

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Book Description

This book presents the health reform experiences over the past three decades of twelve small and medium-sized nations that are not often included in international comparative studies in this field. The major conclusion of the study is that despite many similarities in policy goals, policy challenges and in the menu of policy options for countries that seek to offer universal coverage to their population, the health reforms of the nations in this book did not converge into one direction or model. However, we found several widespread policy experiences that are relevant for others, too.For example, user fees are unpopular everywhere. Governments often try to soften the consequences by exempting large groups of users, thus largely defeating the very purpose of those fees.As a second example, the introduction of new payment modes for medical care — like the shift from fee for service to case-based payment — took much longer than originally expected everywhere, and also failed to deliver their promises of improved transparency or efficiency gains A third example is that proposals are for universal coverage often ignore the challenges of implementing new financing models that elsewhere took decades if not centuries to develop.The conclusions contain both empirical findings and theoretical conclusions of interest to policy-makers and scholars of international comparison. It is accessible for academics, healthcare managers and students as well as a wider audience of readers interested in the changes in healthcare across the world.



Healthcare Access

Author : Umar Bacha

Publisher : BoD – Books on Demand

Page : 175 pages

File Size : 17,10 MB

Release : 2020-05-27

Category : Medical

ISBN : 1838801316

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Book Description

Healthcare Access - Regional Overviews is a compilation of ten chapters consisting of case studies, research works, reviews, and expert opinions providing insight on the previous and current developments in the field of hygiene and infection control with practices to prevent or minimize the spread of infectious diseases. The book also addresses the status and healthcare access of the most neglected segments in less developed countries. All chapters are written by global researchers are edited by experts in the field. The information presented in this work can be replicated at different levels to accelerate timely and quality healthcare services.



Intermediate Public Economics, second edition

Author : Jean Hindriks

Publisher : MIT Press

Page : 1013 pages

File Size : 18,4 MB

Release : 2013-04-05

Category : Political Science

ISBN : 0262313804

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Book Description

A new edition of a comprehensive text, updated throughout, with new material on behavioral economics, international taxation, cost-benefit analysis, and the economics of climate policy. Public economics studies how government taxing and spending activities affect the economy—economic efficiency and the distribution of income and wealth. This comprehensive text on public economics covers the core topics of market failure and taxation as well as recent developments in both policy and the academic literature. It is unique not only in its broad scope but in its balance between public finance and public choice and its combination of theory and relevant empirical evidence. The book covers the theory and methodology of public economics; presents a historical and theoretical overview of the public sector; and discusses such topics as departures from efficiency (including imperfect competition and asymmetric information), issues in political economy, equity, taxation, fiscal federalism, and tax competition among independent jurisdictions. Suggestions for further reading, from classic papers to recent research, appear in each chapter, as do exercises. The mathematics has been kept to a minimum without sacrificing intellectual rigor; the book remains analytical rather than discursive. This second edition has been thoroughly updated throughout. It offers new chapters on behavioral economics, limits to redistribution, international taxation, cost-benefit analysis, and the economics of climate policy. Additional exercises have been added and many sections revised in response to advice from readers of the first edition.



The Political Economy of Universal Healthcare in Africa

Author : Philip C. Aka

Publisher : Taylor & Francis

Page : 98 pages

File Size : 38,75 MB

Release : 2022-04-27

Category : Business & Economics

ISBN : 1000580687

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Book Description

The global rise in pandemics, most recently COVID-19, and other health challenges, some of which are due to climate change, have imposed significant challenges on the healthcare systems in economies around the world. Thus, this book deals with an issue that is very timely and relevant, not just in Africa but globally. It critically assesses healthcare reforms in Ghana under the Fourth Republic, since 1993. Although it focuses on Ghana’s National Health Insurance Scheme of 2003, the book instructively goes beyond this program. The book argues that, although Ghana is a bellwether of healthcare reforms in Africa, its healthcare initiatives are still far from the service haven of healthcare as a human right. Themes that animate the book’s argument include the need to translate human rights law, such as the right to health, into practical policies that work for ordinary citizens. Key highlights of the book include an increased accent on health as a human right, emphasis on comparative analysis in healthcare studies, and the formulation of a four-hallmark framework, embedded in economics, law, politics, and human rights, to act as a guide for assessment of healthcare reforms in Africa in particular, and Ghana more specifically. Using Ghana as a case study and analytical window into the world, the book offers a valuable and timely resource for academics, students and policymakers across the disciplines of development and healthcare economics, law, public policy, political science, sociology, and African and Caribbean studies, as well as in various fields in health science.



Health Insurance Handbook

Author : Hong Wang

Publisher : World Bank Publications

Page : 141 pages

File Size : 49,12 MB

Release : 2012-01-18

Category : Business & Economics

ISBN : 082138953X

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Book Description

Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well to provide financial risk protection.



Crossing the Global Quality Chasm

Author : National Academies of Sciences, Engineering, and Medicine

Publisher : National Academies Press

Page : 399 pages

File Size : 21,74 MB

Release : 2019-01-27

Category : Medical

ISBN : 0309477891

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Book Description

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.