Progressivity of health care financing and incidence of service benefits in Ghana

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. This article reports on a comprehensive assessment of the financing and benefit incidence of health services in Ghana. Findings show that Ghana’s health care financing system is progressive, driven largely by the progressivity of taxes. The NHI levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed.