Financial viability of district mutual health insurance schemes of lawra and sissala East districts, upper west region, ghana.

INTRODUCTION The National Health Insurance Act, passed in 2003 mandates the National Health Insurance Authority to, in conjunction with the district assemblies establish district mutual health insurance scheme (DMHIS) governed by semi-autonomous boards in all ten regions. Since its implementation, unsubstantiated reports indicate increasing health care and administrative costs of the various DMHIS across the country without any corresponding increase in the premium level. We sought to assess the financial viability of the DMHIS in Lawra (LDMHIS) and Sissala East (SEDMHIS) districts, Upper West Region of Ghana. METHODS Cost analysis of revenue and expenditure of LDMHIS and SEDMHIS from 2004 to 2007 was used to estimate the revenue, expenditure, administrative cost, expense, claims and combined ratios. RESULTS The scheme's major sources of revenue were funds from NHIA on behalf of exempted group and the formal sector employees and premium collected from the informal sector. Other sources of revenue were significant at the beginning and became almost negligible at the end of 2007. At the end of 2005, administrative cost was higher than medical claims. By the end of 2007, it has reduced to 34.3% and 15.7% of the total expenditure of the SEDMHIS and LDMHIS respectively. The combined ratios decreased from 2.27 and 1.17 in 2005 to 0.74 and 0.95 in 2007 for SEDMHIS and LDMHIS respectively. CONCLUSION Continuous NHIA support, increasing coverage of the scheme and a corresponding reduction in administrative cost would increase revenue. If this is sustained, the schemes could be financially viable in the long term.