20 Years in the Making: Reflecting on NHIS Costs and Coverage

This year the National Health Insurance Scheme celebrates the 20th anniversary of its original inception under Act 650 passed by the Parliament of Ghana in 2003. The NHIS was designed to promote equitable access to quality healthcare in Ghana, and so on this historic commemoration, it seems only right to explore whether the scheme’s current costs and coverage of health conditions fulfill that goal. 

The NHIS reports that it provides coverage for over 90% of medical conditions that are present at healthcare facilities in Ghana. There is however a list of healthcare services for which the NHIS provides no coverage, and for which Ghanaians in need of these procedures or treatment must pay out of pocket.

While there is an exhaustive list of medical procedures and services excluded from NHIS coverage on the NHIS website, perhaps the most notable are dialysis for chronic kidney failure, non-emergency heart and brain surgery, cancer treatment other than cervical and breast cancer, organ transplantation, HIV antiretroviral medicines. The lack of NHIS coverage for these lifesaving but expensive medical procedures and services leaves millions of Ghanaians without a financial path to access to quality care. 

There have been calls from citizens and healthcare professionals across Ghana to expand NHIS coverage to include some if not all of the aforementioned procedures that are uncovered by the current scheme. This expansion however raises concerns over increased NHIS premiums and taxation. 

It is first important to clarify the current apparatus that funds the NHIS. The majority of NHIS registered cardholders will pay an annual premium set at a minimum of ¢7.2 and a maximum of ¢48 GHS. However, children below the age of 18 years and elders who are 70 years or older who register for NHIS coverage are exempt from this premium along with contributors to the Social Security and National Insurance Trust (SSNIT). 

Beyond premiums charged for individual registration, the NHIS gets its funding from the National Health Insurance Levy (NHIL), which as of an amendment passed this year amounts to a 2.5% levy on all goods and services collected under the Value Added Tax (VAT). Those who oppose the expansion of NHIS coverage posit that an increase in coverage would warrant a consequent increase in the NHIL. 

As a social intervention program that seeks to universalize accessible and affordable healthcare, the NHIS has made providing coverage for poor and vulnerable populations in Ghana a core priority. While the NHIS has done well to increase access to healthcare for millions of people across the country, expanding coverage to include the aforementioned exempted conditions that afflict many Ghanaians is essential in providing a comprehensive healthcare insurance scheme, even if higher taxes must be imposed.