National Health Insurance Levy Uncapped: The Game Changer

Ghana's National Health Insurance Scheme (NHIS) has been hailed as a vital component of Universal Health Coverage (UHC) across sub-Saharan Africa. Established under the National Health Insurance Act 2003 (Act 650), the NHIS aimed to provide financial protection against healthcare costs for all residents and visitors in the country. Following the enactment of Act 2012 (Act 852), the National Health Insurance Authority (NHIA) assumed responsibility for consolidating the NHIS gains and improving governance.

Section 27(1) of the National Health Insurance Act, 2012 (Act 852) obliges every Ghanaian resident to be a member of the NHIS, with private health insurance schemes being an option. While membership is mandatory, enforcement in the informal employment sector remains voluntary. The Scheme aims to provide comprehensive coverage for around 95% of recorded diseases in Ghana, exempting certain vulnerable groups from paying registration fees and annual premiums.

The NHIS benefit package encompasses outpatient, inpatient, oral health, eye care, and maternity services, among others. However, it excludes expensive procedures like heart and brain surgery, VIP accommodations, organ transplants, and treatments abroad. The Scheme's benefits have expanded to include mental health treatment, four childhood cancers, dialysis, family planning, and specific medications, driven by continuous expansion and the need to reduce out-of-pocket costs.

Despite these improvements, the NHIS faced funding challenges due to the capped National Health Insurance Levy (NHIL) and the 25% earmarked funds allocation. As of mid-year 2026, the Scheme had achieved impressive 70% national population coverage, largely thanks to community-focused campaigns and digital innovations like the market storm, campus connect, and mobile renewal short code *929#.

The NHIS relies primarily on the NHIL, a 2.5% levy on VAT, as its primary funding source, complemented by Social Security contributions, NHIF investments, and other government and private sector revenues. However, the 2017 Earmarked Funds Capping and Realignment Act (Act 947) reduced the allowable statutory earmarked funds to 17.5%, impacting the NHIS's financial stability and exacerbating cash flow issues.