**7.1 Success factors and red flags of Ghana's National Health Insurance Scheme**

Ghana's National Health Insurance Scheme (NHIS) was established in 2003 by an act of parliament (Act 650, 2003 [22], revised by Act 852, 2012 [23]) to provide equitable health care to all residents of Ghana. The NHIS was meant to be pro-poor recognizing the gap in health care between the poor and the rich in access to health. Funding of the scheme is tax-based (3.5%) which accounts for the National Health Insurance Levy, an indirect value-added tax on purchase of goods and services; it is also financed by a voluntary contribution (NHIS Premiums of the informal sector population GHS240 (\$34.00, in 2022 exchange rate), and social security contribution (2.5%) applied to formal sector employees, and other financing sources such as grants, donations, and investments returns. It is worth noting that about 75% of the total NHIS funding is from NHIS Levy. The scheme has a comprehensive and generous benefits package covering closed to 90% of all diseases, health conditions, and accidents. However, major and complicated surgeries often may not be covered. Medications and prescribed drugs are covered, but most often there are limited supply of essential medication at the hospitals, and patients are given prescription paid out-of-pocket [6, 22, 23].

After almost two decades of its implementation, the scheme has still attained the required universal population coverage. Only about 50% of diverse groups of the population have enrolled in the NHIS, which raises the question why are the rest of the 50% not covered under the NHIS? What is not going right in the NHIS policies and strategies? Notwithstanding the challenges, the NHIS is considered a best practice scheme for replication on other African and other LMICs. In the following section, I analyze the success factors but also indicate the red flags of Ghana's NHIS. As much as these success factors can be replicated or adopted in other countries on their paths to health insurance, it is important to note that replication of these success factors in other LMICs should be done with caution in the cultural-specific and political context of the country. The underlying key factors that influence the success of Ghana's NHIS are illustrated in **Table 3**. The list is not exhaustive, as suggested by Anarwat and Shepard in 2020.

## **7.2 Thailand's universal health care coverage scheme (UCS)**

Thailand's National Health Insurance Scheme (UCS) was established in 2001. The UCS is organized in three different forms of schemes: 1. Social Security Scheme *Health Insurance for Economically Disadvantaged People in LMICs: What are the Best Options? DOI: http://dx.doi.org/10.5772/intechopen.105679*


#### **Table 3.**

*Success factors and red flags of Ghana's NHIS.*

(SSS) for private sector workers; 2. Civil Servants' Medical Benefits Scheme (CSMBS) for government employees, their spouses, dependents less than 20 years, and their parents; and 3. UCS for the rest of the population which aims to cover all the population not covered by the SSS, mostly informal sector workers.

The UCS has 99.8% population coverage. It is funded through a combination of taxes and contribution (premium) from members. This premium is exceptionally low, about 30 Baht (\$1.00) the starting based level [25]. The success factors and challenges are illustrated in **Table 4**.
