• Premiums paid by informal sector workers, set at about US$8 per adult by the NHIA • Other funds voted by Parliament from general revenue and designated to cover the costs of exempt populations • Additional income from investments, loans, and donations. The dedicated VAT is the most important funding stream, accounting for 70 percent to 75 percent of revenue. Formal sector social security contributions are next, making up 20 percent to 25 percent, and informal sector premiums represent the smallest share, at 5 percent. However, large parts of the population are exempt from any payment, including all minors under 18, all adults over 70, pensioners, and the indigent. The ministry of health has calculated that the exempt groups may account for as much as 70 percent of the population (Back and Graymore 2007). By 2008, 48 percent of Ghana’s population held an NHIS membership card, according to the NHIA. An additional 10 percent had enrolled in NHIS but not yet received a membership card. Coverage rates varied substantially by region, ranging from 13 percent to 70 percent. As of 2007, roughly 40 percent of the lowest income quintile was enrolled, compared to 70 percent of the highest income quintile (Ballou-Aares et al. 2008).
The National Health Insurance Drug Benefit The drug benefit was not financed with a separate flow of funds but through the general funding mechanisms described above. Separate financing from various donors covers some specific drugs, such as those for HIV/AIDS and TB and psychiatric medicines. The systems for supplying these medicines operate outside the NHIS drug coverage scheme. For example, antiretrovirals are provided separately under Ghana’s National AIDS Control Program. The NHIS benefit package covered all drugs on the NHIA Medicines List (which is more extensive than the separate essential medicines list established by the Ghana National Drugs Program). District-level schemes must adhere to the benefit package by covering 28 therapeutic classes and hundreds of different drugs and formulations (Ghana NHIA 2009). The NHIA Medicines List is supposed to set a maximum reimbursement price for each drug, based on the median price in the market (Seiter and GyansaLutterodt 2009). Some reports suggest, however, that pharmaceutical companies greatly influenced the prices that were initially specified (Rajkotia, 2007). For an overview of the general pharmaceutical market in Ghana, see annex J1. Drug Coverage in Ghana’s National Health Insurance Scheme
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