Table 4

Summary of challenges to financial sustainability in NHIS


Current challenges

Funding sources

Majority of income grows with growth in consumption, not with membership.

Very low premia for informal sector in relation to cost of care.

Benefits package

Benefits package comprises an estimated 95% of all treatments in Ghana, with no limit to consumption.


Large proportion of population is exempt and these categories continue to grow

Membership is growing and with a growing rate of utilisation by members

Payment systems

Prices have risen with new DRG payment system

Drug costs additional – incentive to over-prescribe

Anecdotal evidence of 'tariff creep' and gaming by providers

Reported increase in fraudulent claims

Increasing role of private sector (increases access but also raises costs)


No co-payments

Gate-keeping not effective – patients self-refer to secondary hospitals and tertiary ones use their polyclinics as an entry point into specialist care


Poor monitoring and control systems within the NHIS, although a new IT system is being introduced which may improve the situation

Witter and Garshong BMC International Health and Human Rights 2009 9:20   doi:10.1186/1472-698X-9-20

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