A Review of the National Health Insurance Scheme and the Possibility of a Single Premium for a Decade

Table of Contents

1.0 Background

1.1 The history of the Kassena-Nankana District Mutual Health Insurance Scheme

1.2 Problem Statement

1.3 General objectives

1.4 Justification

1.5 Hypothesis

1.6 Scope and expected outcome

2.0 INTRODUCTION

2.1 Insurance

2.2 Critiques of the NHIS

2.3 MEANS OF GENERATING INCOME TO SUSTAIN A SCHEME

2.4 Chapter summary

3.0 RESEARCH METHODOLOGIES

3.1 The research design

3.2 Qualitative data technique

3.3 Quantitative data technique

3.4 The population of the study

3.5 The Sample Size of the Study

3.6 Data collection techniques

3.7 Chapter summary

4.0 RESEARCH FINDINGS, ANALYSIS AND DISCURSIONS

4.1 Background of the respondents

4.2 Membership profile

4.3 Designing a model for the single premium calculation

4.4 The sufficiency of the net single premium to provide for the claim

4.5 The probability that the net single premium will cover the claim (feasibility)

4.6 Chapter summary

5.0 Introduction

5.1 Summary of findings

5.2 Recommendations

5.3 Chapter Summary

Objectives and Research Themes

This research evaluates the performance of the National Health Insurance Scheme (NHIS) within the Kassena-Nankana District, specifically focusing on the feasibility of implementing a single premium system to ensure long-term financial sustainability for the scheme over a decade.

• Review of the National Health Insurance Scheme in Ghana
• Administrative, client-related, and provider-side challenges of the current NHIS
• Design of a mathematical model for a single premium calculation
• Assessment of the feasibility and sufficiency of a single premium for a ten-year duration
• Exploration of alternative income-generating streams for the scheme

Excerpt from the Book

Summary of Chapters

CHAPTER ONE: Provides the historical background of health insurance in Ghana and establishes the problem statement, research objectives, and scope regarding the NHIS in the Kassena-Nankana District.

CHAPTER TWO: Presents a literature review covering basic insurance definitions, NHIS critiques, and theoretical methods for generating income to sustain health insurance schemes.

CHAPTER THREE: Outlines the research methodology, describing the mixed-method approach (qualitative and quantitative) and the data collection techniques used for the study.

CHAPTER FOUR: Details the empirical findings, including a mathematical model for calculating a single premium and an analysis of the sufficiency and feasibility of that premium over a decade.

CHAPTER FIVE: Summarizes the research findings and provides recommendations for stakeholders, including suggestions for computerization, advocacy against moral hazards, and future revenue strategies.

Keywords

Insurance, Single premium, Health Insurance, Premium, NHIS, Kassena-Nankana District, Actuarial Science, Healthcare sustainability, Mathematical modeling, Financial feasibility, Moral hazard, Public health administration, Ghana, Social Health Insurance, Statistical survey.

Frequently Asked Questions

What is the core focus of this research?

The research investigates the current state of the National Health Insurance Scheme (NHIS) in the Kassena-Nankana District of Ghana and examines the mathematical and practical viability of implementing a single, lifetime-style premium system to sustain the scheme over a ten-year period.

What are the central themes discussed in the paper?

Key themes include administrative difficulties like installment collections, client-related issues such as moral hazards and misconceptions about the scheme, and financial challenges related to high tariffs and the need for sustainable revenue streams.

What is the primary objective of the study?

The main objective is to determine if a single premium model is feasible to improve and sustain healthcare delivery in the district, thereby moving away from the challenges associated with the current annual premium system.

Which research methodology was utilized?

The author employed a mixed-method approach, utilizing a statistical survey that combined qualitative data (analyzed via pie charts) and quantitative data (utilizing actuarial models like DeMoivre’s Law and force of interest calculations).

What does the main body of the work cover?

The main body moves from a contextual and theoretical literature review into a detailed empirical analysis, which includes demographic profiling of respondents and a technical derivation of a single premium calculation model.

Which keywords define this work?

Key terms include insurance, single premium, health insurance, actuarial science, financial feasibility, moral hazard, NHIS, and healthcare sustainability.

What did the author conclude regarding the single premium?

The author concluded that a single premium is mathematically feasible under certain actuarial assumptions, provided the model is adjusted for the age and locality of the insured, noting that the calculated single premium for a decade would be GH₵ 0.4 based on specific average bill assumptions.

What administrative recommendations are provided?

The author strongly recommends full computerization of the administrative and accounting systems to eliminate the inefficiencies of manual record-keeping and to better manage installment payments.

How is the issue of "moral hazard" addressed?

The study suggests that organized public forums and advocacy campaigns are necessary to educate clients on the health implications of abusing the system and to curb intentional, unnecessary hospital visits.