Health Insurance in Ghana

The National Health Insurance Scheme in Ghana is deemed as one of the legacies of the John Kufuor administration. Seeking the mandate of the people in the 2000 elections, Kufuor promised to abolish what was known at the time as the “cash and carry system” of health delivery. Under this system, patients – even those who had been brought into the hospital on emergencies – were required to pay money at every point of service delivery. Imagine being sent to a hospital with a bleeding accident wound and being asked to pay before a doctor attends to you. People died. In some cases, lives were lost for the simple reason that friends and relatives were not around to make the required advanced payment.

So when Kufuor won the election of 2000 he was determined to get rid of “cash and carry”, replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment. Despite Kufuor’s determination his government was only able to pass to National Health Insurance Act about three years after his election. But he lived up to his promise to abolish “cash and carry” and today, the Health Insurance Scheme in Ghana is seen as one of the positive legacies Kufuor will be most remembered for.

Under the law, there is a National Health Insurance Authority which licences, monitors and regulates the operation of health insurance schemes in Ghana.

Types of health insurance

There are three main categories of health insurance in Ghana.

The first and most popular category is the district mutual health insurance scheme, which is operational in every district in Ghana. This is the public/non-commercial scheme and anyone resident in Ghana can register under this scheme. If you register in ‘District A’ and move to ‘District B’, you can transfer your insurance policy and still be covered in the new district. The district mutual health insurance scheme also covers people considered to be indigent – that is too poor, without a job and lacking the basic necessities of life to be able to afford insurance premiums.

Apart from the premium paid by members, the district mutual health insurance schemes receive regular funding from central government. This central government funding is drawn from the national health insurance fund. Every Ghanaian worker pays two-and-a-half percent of their social security contributions into this fund and the VAT rate in Ghana also has a two-and-a-half percentage component that goes into the fund.

To sign up for the district mutual health insurance scheme, you need to get to the district assembly where you reside or look for the offices of the scheme and register. You will fill a form, offering some basic personal information and you will be asked to present at least two passport pictures. You will need to fill forms for dependants above below 18 as well.

The second category of health insurance comprises the private commercial health insurance schemes, operated by approved companies. You can just walk into any of such companies and buy the insurance for yourself and dependants – just as you would a car. Commercial health insurance companies do not receive subsidy from the National Health Insurance Fund and they are required to pay a security deposit before they start operations.

The third category of health insurance is known as the private mutual health insurance scheme. Under this, any group of people (say members of a church or social group) can come together and start making contributions to cater for their health needs, providing for services approved by the governing council of the scheme. Private mutual health insurance schemes are not entitled to subsidy from the National Health Insurance Fund.

Benefits of health insurance

If you register under any of the schemes, you will be given a card which you can use to seek treatment in any hospital in the country. When you visit a health facility with the card, you are treated and offered the services you have signed for without you having to pay for anything – unless you ask for an extra service, like a private ward. Your bills are then sent to your scheme provider (district, private scheme or mutual scheme) which then pays the money to the hospital. You can also use your card to buy prescribed drugs at accredited pharmacies or licensed chemical shops without paying at the point of delivery – the pharmacy will contact your service provider to take its money.

At least, that’s how the system is supposed to work on paper. But there have been reports of some hospitals and pharmacies turning patients away, complaining that the public health insurance schemes owes them huge amounts of money. Some of the big hospitals in the country have often been compelled to issue public statements warning that their operations could grind to a halt if the Health Insurance Authority (NHIA) doesn’t speed up the payment of their claims. The NHIA has assured that it is working on these problems and in due course, they will be resolved.

Whatever form of health insurance you sign up to entitles you to some minimum services. These are:

• Out-patient services – general and specialist consultations reviews, general and specialist diagnostic testing including, laboratory investigation, X-rays, ultrasound scanning, medicines on the NHIS Medicines list, surgical operations such as hernia repair and physiotherapy.
• In-patient services – General and specialist in patient care, diagnostic tests, medication-prescribed medicines on the NHIS medicines list, blood and blood products, surgical operations, in patient physiotherapy, accommodation in the general ward and feeding (where available).
• Oral health – pain relief (tooth extraction, temporary incision and drainage), dental restoration (simple amalgam filling, temporary dressing)
• Maternity care – antenatal care, deliveries (normal and assisted), Caesarean section, post-natal care
• Emergencies – these refer to crises in health situations that demand urgent attention such as medical emergencies, surgical emergencies, paediatric emergencies, obstetric and gynecological emergencies and road traffic accidents.

Excluded Services

Your health insurance does not entitle you to all medical procedures and health services. If you require any of the following you may need to pay more:

Appliance and prostheses including optical aids, heart aids, orthopaedic aids, dentures etc.
• Cosmetic surgeries and aesthetic treatment
• Anti-retroviral drugs for HIV
• Assisted Reproduction (e.g. artificial insemination) and gynecological hormone replacement therapy.
• Echocardiography
• Photography
• Angiography
• Dialysis for chronic renal (kidney) failure
• Organ transplants
• All drugs that are not listed on the NHIS list
• Heart and Brain Surgery other than those resulting form accidents
• Cancer treatment other than breast and cervical
• Mortuary Services
• Diagnosis and treatment abroad
• Medical examinations for purposes other than treatment in accredited health facilities (e.g. Visa application, Education, Institutional, Driving license etc)
• VIP ward (accommodation)