A Tax-Funded Health Insurance Model for Universal Coverage in Ghana
Download the Full PaperExemplar Overview
This exemplar examines Ghana's National Health Insurance Scheme (NHIS), financed primarily through the National Health Insurance Levy (NHIL), and the impact of the 2025 uncapping reform that restored full funding to the scheme.
Ghana established the National Health Insurance Scheme (NHIS) in 2003 under Act 650 to replace the 'cash-and-carry' system. The scheme is financed through multiple streams, primarily the 2.5% National Health Insurance Levy (NHIL) on consumption, payroll contributions, and premiums. The NHIL provides about 70% of NHIS revenue. In March 2025, the government uncapped the NHIL, directing 100% of proceeds to the National Health Insurance Fund. This raised the allocation from GHS 5.9 billion in 2024 to GHS 9.93 billion in 2025 (a 66% increase), with GHS 49.3 billion earmarked for 2025–2028 to resolve provider reimbursement delays and expand coverage.
Policy Recommendations
Earmarked taxation is a powerful domestic resource mobilization tool, but its stability depends on protecting funds from general budget capping.
Uncapping reforms can immediately unlock massive fiscal space for national health insurance schemes when political commitment is aligned.
Digital enrollment and payment systems reduce administrative friction and help sustain membership coverage in both formal and informal sectors.
A comprehensive benefit package that covers prevalent chronic diseases and childhood cancers builds trust and increases utilization.
Key Numbers
Increase in NHIS budget allocation in 2025
Active members covered under NHIS
Of NHIS revenue provided by the NHIL levy
Of disease conditions covered under the scheme
Key Findings
The 2.5% NHIL levy on consumption provides approximately 70% of NHIS revenue, serving as a continental model for earmarked health taxation.
Uncapping the NHIL in March 2025 led to a 66% year-on-year funding increase, raising the allocation from GHS 5.9 billion to GHS 9.93 billion.
The National Health Insurance Scheme (NHIS) covers over 16 million active members, representing approximately 68–72% of the population.
NHIS provides coverage for an estimated 95% of disease conditions, including malaria, diabetes, hypertension, and childhood cancers.