Tackling Fraud and Unofficial Payments within the NHIS
By Dr. Cynthia Bannerman, Deputy Director Quality Assurance, Ghana Health Service
(This blog is cross-posted from The Joint Learning Network with permission) - Fraud, abuse and unofficial payments are threats to the sustainability of health insurance schemes. Over the last two years, Ghana’s National Health Insurance Authority (NHIA) has recouped 18 Million Ghana Cedis ($7.4 Million USD) charged through fraudulent claims by service providers.
We know that fraud and abuse are not unique to Ghana, and can never be completely eliminated. However, interventions must be put in place to prevent and reduce their occurrence.
Building National Health Insurance: Lessons from Ghana Part II
An interview with Nathaniel Otoo, Director of Administration and General Counsel of the National Health Insurance Authority of Ghana
Nathaniel Otoo is the Director of Administration and General Counsel of the National Health Insurance Authority of Ghana. His 20 years of work experience has spanned both the public and private sectors, with the last 9 of them being in social protection. He holds an LLB Degree from the University of Ghana and a professional qualification in law from the Ghana School of Law. He also holds an MA degree in International Relations from the International University of Japan. Mr. Otoo has played a key role in the ongoing legal reforms in Ghana’s National Health Insurance Scheme (NHIS).
Wellington: Mr. Otoo, you have worked at the National Health Insurance Association (NHIA) for 6 years. In your opinion, what are some of the key policy decisions that have contributed to the success of the National Health Insurance Scheme (NHIS)?
Otoo: The best policy has been deciding to implement the National Health Insurance Scheme (NHIS).
Research to support universal coverage reforms in Africa
The SHIELD project
In response to the 2005 World Health Assembly resolution on universal health coverage which highlighted the importance of research to create an evidence base for health financing reforms. The Social Health Insurance for Equity in Less Developed countries (SHIELD) project recently published an evaluation of the health systems of three African countries (Ghana, South Africa and Tanzania) in the Oxford Journals.
The SHIELD project critically evaluates the health systems of these three countries, through an equity lens and to the extent to which financing mechanisms could address the equity challenges in these countries.
The Abstract is posted below.
Universal Immunization Through Universal Health Coverage
Editor's Note: This post first appeared on the Management Sciences for Health (MSH) blog. It is re-posted with permission.
A child born in Ghana today will most likely receive a full schedule of immunizations, and her chances of surviving past the age of five are far better than they were a decade ago. Today Ghana boasts a coverage rate for infant vaccination of 90 percent and hasn’t seen an infant die of measles since 2003.
Ghana has been expanding primary health care by bringing services to people’s doorsteps since the 1980s, and since the early 2000s has done so in the context of a commitment to universal health coverage.
Raising Revenue to Cover the Informal Sector
Different strategies for raising revenue to cover the informal sector
Panelists representing Ghana, Mali, Indonesia, Rwanda and the World Bank discussed the challenges of raising revenues for covering the informal sector at the JLN workshop session in Mombasa on June 7, 2011. Debated were the relative merits of different strategies for raising revenues such as general taxes, payroll taxes, special earmarked taxes, donor and community contributions.
During the June 7, 2011, JLN workshop session on raising revenue to cover the informal sector it emerged that most countries, in fact, utilize a mix of financing sources, although one source may be more dominant than the others. The financing source may also differ according to the population group(s) being targeted – thus payroll taxes tend to predominate when it concerns the formal sector, while a mix of sources is more relevant to cover the informal sector due to the many complexities of raising sufficient premium income from that sector and the large numbers who may not be able to pay premiums for themselves.
Public-Private Engagement for Better Health in Africa
New World Bank Group Report Assesses the Good, the Bad, and the Innovative
Connor Spreng, an economist at the World Bank, moderated a session on the IFC flagship report "Healthy Partnerships: How Governments Can Engage the Private Sector to Improve Health in Africa" at the JLN Mombasa Workshop.