status of nhis and new strategic direction by mr. sylvester a. mensah,

8/6/2019 Status of Nhis and New Strategic Direction by Mr. Sylvester a. Mensah,

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STATUS OF NHISAND NEW

STRATEGIC DIRECTIONMr. Sylvester A. Mensah

Chief Executive Officer, NHIAHealth summit, GIMPA, Accra

Tuesday, 17th

November 2009


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PRESENTATION OBJECTIVE

To present a snapshot of the main themesrelating to the success and sustainability of

Ghanas National Health Insurance system,and the current strategic direction


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OUTLINE OF PRESENTATION

Introduction

Implementation outputs

Challenges

Strategic direction

Conclusion


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INTRODUCTIONNHIS of Ghana established by National

Health Insurance Act, 2003 (Act 650) andNational Health Insurance Regulations, 2004(L.I. 1809)

3 types of health insurance schemes - allregulated by National Health InsuranceAuthority (NHIA)

Policy objective of the National HealthInsurance Scheme (NHIS) is to secure theprovision of basic healthcare services to

persons resident in the country


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IMPLEMENTATION OUTPUTS

Membership (cumulative as at June 2009)

13,840,198 registered (67% population 2004

estimates) 12,146,526 total ID cards issued to date

87.8% of registered to date issued cards

309,110 indigents registered

721,163 pregnant women under free maternalcare since July 2008


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Implementation Outputs (2)

Accreditation of providers

Provisionally accredited: all public and

CHAG facilities (about 4,000) and 1,551private facilities

Formal accreditation: 618 facilities inspected

Inspection has begun for 1,200 morefacilities


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Implementation Outputs (3)

NHIS ICT platform (870 sites hooked up)

NHIS uniform ID card

G-DRG tariffs and NHIS Medicines List

Implemented since April 1, 2008 Review of Medicines List completed and in

effect since 1st October 2009; tariffs review inpreparatory stages


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CHALLENGES

Claims administration

Fragmentation and Autonomy of DMHIS

Standardisation and Governance

Weak portability

Weak control systems that provide apotential for fraud

Weak enforcement of gatekeeper system(referral system)

Difficulty identifying indigents and the poor

Misapplication of approved tariffs

Prescribing and dispensing of unapproved

medicines


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STRATEGIC DIRECTION

Goal

To deliver on the NHIS promise of

providing access to quality basic health carefor all residents of Ghana


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Strategic Direction (2)

Strategic Objectives (Sep 09 Dec 10) are to:

Implement one-time premium

Review legislative framework

Improve claims administration

Achieve full portability with fully

operational ICT solution Overhaul NHIS communication strategy


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Implement one time premium payment

Preliminary actuarial analysis concluded

and submitted to Government for studyReview legislative framework

Aims to remove implementation

bottlenecks To be completed by the end of 2009


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Improve claims administration Pilot claims centre in Accra

Pilot electronic claims submission with MamobiPolyclinic

Achieve full portability

Address ICT implementation challenges

Improve ID card production-distribution cycle

Overhaul communication strategy Increased engagement with stakeholders

Innovative marketing of the scheme


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CONCLUSION

NHIS has been acceptedAchievements and challenges are recognised

Strategies have been advanced towards:

One National Scheme. one corporate entity,one governing board

One ID card, one ICT platform

One premium, one-time payment

One claims administration system


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Thank you!!

status of nhis and new strategic direction by mr. sylvester a. mensah,

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