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NHIS PRESENTATION AT THE HEALTH SUMMIT

NHIS PRESENTATION AT THE HEALTH SUMMIT. PRESENTATION BY RAS A. BOATENG CHIEF EXECUTIVE OFFICER NHIA. OUTLINE OF PRESENTATION. Status of Implementation Regional Percentages Implementation issues HRD Initiatives by Council The New ICT Solution End of Presentation.

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NHIS PRESENTATION AT THE HEALTH SUMMIT

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  1. NHIS PRESENTATION AT THE HEALTH SUMMIT PRESENTATION BY RAS A. BOATENG CHIEF EXECUTIVE OFFICER NHIA

  2. OUTLINE OF PRESENTATION • Status of Implementation • Regional Percentages • Implementation issues • HRD Initiatives by Council • The New ICT Solution • End of Presentation

  3. STATUS OF IMPLEMENTATION Schemes in operation: 143 Total registered members: 11,298,820 (55%) Total membership: 9,805,176 (48%) Total ID card bearers: 8,451,610 (41%) % to Total Registered: Informal 22% Aged 7% Under 18 45% SSNIT 9% Pensioners 1% Indigents 2%

  4. Outlook for 2007 • Expand coverage to 55% of population by end of 2007 (2007 budget statement) • Baseline (December 2006) 38% • Actual (September 2007) 55% Percentage increase December 2006 to Sept 2007 44.7%

  5. Public Education and Brand Building • Sustain public education to increase awareness of benefits and reduce misconception about the scheme On-going activities: • TV documentaries and live educational programmes (Mma Nkomo) • Radio and TV Jingles and Commercials • Print Media Adverts • Mobile Bill Boards/Outdoor adverts (MMT buses)

  6. Public Education Public and Brand Building • Press conferences and News Releases • Radio Talk Shows and Programmes • Public Addresses, Workshops and Seminars • Educating Ghanaians in the Diaspora • Local Publicity at the district levels

  7. Public Education and Brand Building continued • Registration & empowerment campaigns • Drama groups and Concert Parties • Radio and TV Drama programmes • Radio and TV Quiz programmes • Newspaper articles and insertions • NHIS health tip-bits on radio and TV • Use of NHIS ambassadors such as Stephen Appiah

  8. Monitoring and Supervision • Step up Monitoring and Supervision • 10 zonal offices established in all regional capitals • Recruitment of zonal heads completed Expected Outcome improved monitoring and supervision

  9. HRD INITIATIVES BY COUNCIL • Investment in health human resource • health assistants training programme • Capacity building of scheme management • Human resource needs assessment completed • Nuffic multi-year agreement programme • ILO five year training programme (in the pipe line) • World Bank Project

  10. SSNIT INSURED MEMBER’S PREMIUMS Health Insurance Levy Other Funds Transfer of Funds HUB NHIC & Secretariat which holds the funds in the National Health Insurance Fund Transfer of funds and technical support to Satellites Insured Persons Pay Premium (¢ 72, 000 - ¢ 480, 000 per annum) Directly to DMHIS SERVICE PROVIDERS Hospitals, Pharmacies, Laboratories, Chemical Shops, etc DMHIS DMHIS DMHIS DMHIS EXISTING INSTITUTIONAL FRAMEWORK

  11. Health Insurance Levy Other Funds SSNIT Insured Members’ Premiums Transfer of Funds • Grant accreditation to Healthcare Providers • Promote Health Education HUB NHIC & Secretariat – implementer of National Health Insurance Policy • Manage NHI fund • Register, license & regulate DMHIS • Determine Premiums Transfer of subsidy, reinsurance and technical support through Regional offices to Satellites G. Accra District – 10 G. Accra Regional Office(s) Volta District - 15 Volta Regional Office(s) Ashanti District - 24 Ashanti Regional Office(s) Eastern Regional Office(s) Eastern District - 17 Western District - 15 Western Regional Office(s) Central Regional Office(s) Central District - 13 Northern District - 16 Northern Regional Office(s) B.A District - 19 B.A Regional Office(s) U. East District - 6 U. East Regional Office(s) U. West Regional Office(s) U. West DMHIS – 8 Insured Persons Pay Premium (¢ 72, 000 - ¢ 480, 000 per annum) Directly to DMHIS SERVICE PROVIDERS Hospitals, Pharmacies, Laboratories, Chemical Shops, etc NEW INSTITUTIONAL FRAMEWORK

  12. ICT Solution • Improve systems for registration and claims management by introducing new and robust technology platform • Expected outcome • Uniform ID card introduced • Instant ID card issuance • Improved claims processing • Prompt payment of claims to providers

  13. The Phase Implementation of ICT Solution for NHIS Phase 1 (NHIC Allocation) Phase 2 (IDA Loan) Phase 3 (Future) NHIC Secretariat and Schemes (159) Other Providers (Over 1,000) Internal Networking for Providers (736) Providers' Front Office (736)

  14. ComputerisedNHIS Environment PHASE 1 Subscriber Eligibility Verification Electronic Claims Submission Council PHASE 2 Scheme Main D.B Treatment Data Electronic Claims Management Provider Payment Standard Member ID Card

  15. Description of the Phases in NHIS ICTSolution • Phase 1: NHIC Allocation • Provision of Uniform Technology Platform, Linking the Secretariat with the Schemes and the Front Desk of 736 Providers; • Software Application to support the Operational and Financial activities of the Schemes and the Secretariat including computerized Claims Management System; • Phase 2: IDA Loan • Policy Adaptation and Building Human Resource Capacity for MOH, NHIC, Providers and Schemes; • Internal Connectivity and Software Integration for Linking the Front Desk with the Back Office activities of 736 Providers; • Phase 3: Future • Connectivity for Additional Providers and ICT Platform Improvements.

  16. FINANCIALS 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

  17. SUSTAINABILITY OF NATIONAL HEALTH INSURANCE 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

  18. New Initiatives to Improve Provider Payment Systems • New Tariffs and Medicines list to go into effect in January 2008 • Payment of district schemes subsidy quarterly in advance • Payment of 40% of claims upon submission and prior to vetting

  19. Thank you!

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