PMID- 35842698
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220719
IS  - 1478-7547 (Print)
IS  - 1478-7547 (Electronic)
IS  - 1478-7547 (Linking)
VI  - 20
IP  - 1
DP  - 2022 Jul 16
TI  - Supporting a review of the benefits package of the National Health Insurance 
      Scheme in Ghana.
PG  - 32
LID - 10.1186/s12962-022-00365-0 [doi]
LID - 32
AB  - BACKGROUND: Although Ghana is lauded for its National Health Insurance Scheme 
      (NHIS), concerns exist about the scheme's functioning and sustainability. An 
      often-cited issue-contributing to the scheme's decreasing membership, 
      long-standing financial deficit, and frequent out-of-pocket payments among 
      members-is the large benefits package (BP). While, on paper, the BP covers over 
      95% of the conditions occurring in Ghana, its design was not informed by any 
      budget analysis, nor any systematic prioritization of interventions. This paper 
      aims to provide evidence-based input into ongoing discussions regarding a review 
      of the NHIS benefits package. METHODS: An existing analytic framework is used to 
      calculate net health benefit (NHB) for a range of interventions in order to 
      assess their cost-effectiveness and enable the prioritization of 'best buys'. The 
      framework is expanded upon by incorporating concerns for financial protection, 
      and practical feasibility, as well as the political economy challenges of 
      disinvesting in currently funded activities. Five different options for the 
      benefits package, each based on policy discourse in Ghana's health sector, are 
      presented and evaluated. RESULTS: Implementing all interventions for which data 
      was available to 100% of the population in need was estimated to cost GH₵4323 
      million (US$994 million), while the available NHIS budget was only GH₵970 million 
      (US$223 million). Options for the benefits package that focussed on 
      cost-effectiveness and primary care provision achieved the best health outcomes, 
      while options reflecting the status quo and allowing for co-payments included a 
      higher number of healthcare interventions. Apart from the package option 
      focussing on primary care, all packages were faced with physician shortages. 
      CONCLUSIONS: Current funding to the NHIS is insufficient to provide the 
      historical benefits package, which promises to cover over 95% of disease 
      conditions occurring in Ghana, to the total population. Shifting the NHIS focus 
      from intervention coverage to population coverage is likely to lead to better 
      health outcomes. A primary care package may be most feasible in the short-term, 
      though additional physicians should be trained to provide higher-level care that 
      is highly cost-effective, such as emergency neonatal care.
CI  - (c) 2022. The Author(s).
FAU - Vellekoop, Heleen
AU  - Vellekoop H
AUID- ORCID: 0000-0001-5127-240X
AD  - Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. 
      Box 1738, 3000 DR, Rotterdam, The Netherlands. vellekoop@imta.eur.nl.
AD  - Ministry of Health, Accra, Ghana. vellekoop@imta.eur.nl.
FAU - Odame, Emmanuel
AU  - Odame E
AD  - Ministry of Health, Accra, Ghana.
FAU - Ochalek, Jessica
AU  - Ochalek J
AD  - Centre for Health Economics, University of York, York, UK.
LA  - eng
PT  - Journal Article
DEP - 20220716
PL  - England
TA  - Cost Eff Resour Alloc
JT  - Cost effectiveness and resource allocation : C/E
JID - 101170476
PMC - PMC9287965
OTO - NOTNLM
OT  - Financial risk protection
OT  - Ghana
OT  - Health benefits package
OT  - LMIC
OT  - Political economy
COIS- All the authors have no competing interests to declare.
EDAT- 2022/07/17 06:00
MHDA- 2022/07/17 06:01
PMCR- 2022/07/16
CRDT- 2022/07/16 23:31
PHST- 2021/08/23 00:00 [received]
PHST- 2022/06/21 00:00 [accepted]
PHST- 2022/07/16 23:31 [entrez]
PHST- 2022/07/17 06:00 [pubmed]
PHST- 2022/07/17 06:01 [medline]
PHST- 2022/07/16 00:00 [pmc-release]
AID - 10.1186/s12962-022-00365-0 [pii]
AID - 365 [pii]
AID - 10.1186/s12962-022-00365-0 [doi]
PST - epublish
SO  - Cost Eff Resour Alloc. 2022 Jul 16;20(1):32. doi: 10.1186/s12962-022-00365-0.