LEADER 03925oam 22005655 450 001 9910796047703321 005 20180918124527.0 024 7 $a10.1596/978-1-4648-1117-3 035 $a(CKB)3710000001576681 035 $a(MiAaPQ)EBC4939154 035 $a(The World Bank)211117 035 $a(US-djbf)211117 035 $a(EXLCZ)993710000001576681 100 $a20020129d2017 uf 0 101 0 $aeng 135 $aurcn||||||||| 181 $ctxt$2rdacontent 182 $cc$2rdamedia 183 $acr$2rdacarrier 200 10$aGhana National Health Insurance Scheme : $eImproving Financial Sustainability Based on Expenditure Review /$fHuihui Wang 210 1$aWashington, D.C. :$cThe World Bank,$d2017. 215 $a1 online resource (68 pages) 225 1 $aWorld Bank Studies 311 $a1-4648-1117-2 311 $a1-4648-1118-0 330 3 $aGhana 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. 410 0$aWorld Bank e-Library. 410 0$aWorld Bank Studies 606 $aEfficiency 606 $aExpenditure Control 606 $aFinancial Sustainability 606 $aGhana 606 $aHealth Insurance 607 $aGhana 615 4$aEfficiency 615 4$aExpenditure Control 615 4$aFinancial Sustainability 615 4$aGhana 615 4$aHealth Insurance 676 $a368.42 700 $aWang$b Huihui$01521794 702 $aOtoo$b Nathaniel 702 $aDsane-Selby$b Lydia 712 02$aWorld Bank Group, 801 0$bDJBF 801 1$bDJBF 906 $aBOOK 912 $a9910796047703321 996 $aGhana National Health Insurance Scheme$93807967 997 $aUNINA