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NATIONAL HEALTH INSURANCE COUNCIL PRESENTATION AT MOH-PARTNERS HEALTH SUMMIT – ACCRA 18-04-07

NATIONAL HEALTH INSURANCE COUNCIL PRESENTATION AT MOH-PARTNERS HEALTH SUMMIT – ACCRA 18-04-07. PRESENTATION BY RAS BOATENG CHIEF EXECUTIVE, NHIC. OUTLINE OF PRESENTATION. Implementation status Challenges Way forward Conclusion. PROGRESS. Regional details. UTILISATION AND RATE PER/1000.

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NATIONAL HEALTH INSURANCE COUNCIL PRESENTATION AT MOH-PARTNERS HEALTH SUMMIT – ACCRA 18-04-07

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  1. NATIONAL HEALTH INSURANCE COUNCIL PRESENTATION AT MOH-PARTNERS HEALTH SUMMIT – ACCRA 18-04-07 PRESENTATION BY RAS BOATENG CHIEF EXECUTIVE, NHIC

  2. OUTLINE OF PRESENTATION • Implementation status • Challenges • Way forward • Conclusion

  3. PROGRESS

  4. Regional details

  5. UTILISATION AND RATE PER/1000

  6. CHALLENGES • LACK OF INFRASTRUCTURE TO DO PROPER VETTING OF CLAIMS AND MONITOR FRAUD. • LACK OF RISK SHARING ON THE PART OF SUBSCRIBERS AND PROVIDERS • DIFFICULTY IN IDENTIFYING INDIGENTS FOR FREE COVERAGE. • LACK OF SUITABLE OFFICE ACCOMMODATION FOR SCHEMES .

  7. Challenges Cont’d EXEMPTION POLICY WITHIN HEALTH INSURANCE REGIME MULTIPLE SOFTWARE AND ID CARDS MAKE PORTABILITY DIFFICULT TO MANAGE DRUG LIST AND DIFFERENTIAL TARIFF STRUCTURE VERTICAL PROGRAMS (EG. FREE PUBLIC HEALTH SERVICE)WITHIN THE HEALTH INSURANCE REGIME WEAK TECHNICAL AND MANAGERIAL CAPACITY OF SCHEME MANAGEMENT

  8. WAY FORWARD • ACCELERATE THE PACE OF REGISTRATION AND ISSUANCE OF ID CARDS • TRANSFORM NHIC INTO A SOLUTION BASED ORGANISATION • DEVELOP AND IMPLEMENT AN EFFECTIVE COMMUNICATION STRATEGY; AND • IMPROVE PORTABILITY AND ENSURE QUALITY OF SERVICE

  9. WAY FORWARD CONT’D • INTENSIFY CONTINUED EDUCATION AND TRAINING OF PERSONNEL • DEVELOP COMPREHENSIVE HR POLICIES TO RETAIN COMPETENT STAFF • IMPROVE FINANCIAL SUSTAINABILITY

  10. SUSTAINABILITY OF NHIS OVERVIEW Pooling Risk, Managing Risk Two Sources of Income Operating Margin + Investment Income= Total Income / Loss Contribution to reserve • EXPENSES • Medical Expenses • Provider Contracts • Healthcare Services • Administrative Expenses • Enrollment • Claims • Payroll • IT Expenses REVENUE Premiums Premium Equivalents - = OPERATING MARGIN

  11. SUSTAINABILITY OF NHI FUND Gross InflowsNational Health Insurance Levy SSNIT Insured Members’ Premium Other income (grants , loans) Investment income Allocation from Parliament = Total Inflow Less Reserve requirement Actual Provision Provision for future expenses* 40% = Net Inflow Allocation of Net Inflow to Statutory Expenditure Subsidy to DMHIS 65% Reinsure DMHIS 10% Healthcare cost to Indigent 5% Support Facilitation – provision of access to health care 5% Investment in facilitating health programmes 5% =Total subsidized cost of healthcare 90% NHIC Secretariat Administrative Support 10% Less = Total Expenditure 100% = Surplus / (Deficit) +/- Transfer to Surplus = Accumulated Surplus

  12. Thank you

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