SPECIAL REPORT BY: KWEKU BOLTON
In the bustling city of Accra, Ghana’s capital, where the skyline reflects both promise and challenge, 44 year old Doris Ansah lives a quiet life with her three children. A widow juggling multiple jobs, Doris works tirelessly to provide for her family. Yet one uncertainty haunted her daily: their health.
Doris second child, 12 year old Paa Kwesi, was diagnosed with a chronic illness requiring regular medical attention. Her youngest daughter, nine year old Nana Yaa, suffered from a stomach condition that also demanded treatment. Without health insurance, Doris faced insurmountable medical bills. The quality of care Kwesi and Nana Yaa received often depended on her fluctuating income. The stress was unbearable, and the fear of an unexpected medical emergency loomed like a dark cloud. This revelation came to light during a one-on-one conversation with Doris after visiting the hospital.
A Ray of Hope
Relief came when Ghana’s National Health Insurance Scheme (NHIS) introduced an innovative programme aimed at underserved communities. Powered by mobile technology, the scheme allowed individuals to register and manage their health insurance through smartphones. For Doris, this breakthrough removed the bureaucratic hurdles that had long stood in her way.
She recalled: “I quickly registered my family through the app and, for the first time, felt a sense of relief. My son Kwesi received consistent and high quality medical care without the crushing financial burden.”
Her daughter Nana Yaa also benefited. Doris explained: “As a widow with three children and no support from elsewhere, this initiative has reduced my hospital bills and financial burdens. Thanks to NHIS.”
From Long Queues to Digital Access
When NHIS was first introduced in 2003, registration was plagued by long queues, limited staff, and technical glitches. Rural residents often travelled long distances to reach registration centres, while unclear information about eligibility and documentation caused confusion.
The new system, developed in partnership with tech startups such as HealthNet, transformed access. Its app simplified registration, offered telemedicine services, and provided wellness resources. For thousands of Ghanaians, ’it became a lifeline’’.
A Broader Trend
Doris’s story reflects a wider transformation in health insurance: the integration of technology, data analytics, and community focused programmes. Insurers now analyse health trends to tailor policies to specific communities, breaking down barriers that once excluded vulnerable populations. Data from the German online platform Statista show that, as of 2021, 72% of Ghanaian women had health insurance compared with 64.7% of men.
Private Insurance Stories
While NHIS dominates, private health insurance plays a crucial role. Joe Anan shared his experience: “One day, my father fell ill, and the condition became serious, affecting his life for years. My sister and brother worried constantly as his health deteriorated every day. However, thanks to private health insurance whose name is withheld my father was able to receive medical treatment until his demise. Without the policy, we would have had to sell our family property.” He added that the insurance absorbed major hospital bills, from surgery to expensive drugs, and even extended coverage to some of his siblings.
With technology and innovation, DOSH Health Insurance has partnered with MTN Mobile Money (MoMo) to deliver health insurance directly through the MoMo app, marking a first for mainstream coverage in the country. DOSH Chief Executive, Mr. Frank Dagbui, underscored that “the initiative enables subscribers to enroll, pay premiums, and access services instantly, eliminating paperwork, queues, and traditional banking barriers.” He further highlighted “an extensive healthcare network, which partners with accredited public, private, and faith-based facilities to guarantee quality care.”
By leveraging MoMo’s 17 million active users, the scheme expands healthcare financing with a focus on accessibility, affordability, and availability. It specifically targets families, small businesses, and informal sector workers who are often excluded from private insurance
Alongside DOSH, other health insurance companies across Africa play a crucial role in managing health risks for policyholders. Under policy agreements, insurers are obligated to pay claims, safeguard lives, and provide swift financial support in times of illness. Beyond individual coverage, they contribute significantly to national, continental, and global health initiatives.
National Picture
Health Minister Dr. Kwabina Minta Akando reported: “As of 2024, Ghana’s NHIS had enrolled 18.47 million members, with a target of 20 million by the end of 2025. Currently, 56.3% of Ghanaians are active NHIS members, benefiting from coverage for about 95% of diseases.”
By contrast, Collins Akuamoah, Deputy Director of Research at the National Health Insurance Authority (NHIA), noted that ‘’private health insurance serving mainly corporate clients and individuals seeking faster or specialised care’’. The NHIA has licensed 13 private commercial schemes and one mutual scheme.
Understanding Health Insurance
Health insurance is a vital component of healthcare systems worldwide, offering financial protection to individuals and families against medical expenses. It operates as a contract between policyholders and insurers: subscribers pay premiums, while insurers cover medical costs when treatment is required. Despite its importance, health insurance carries certain risks that may affect its overall effectiveness.
• National Health Insurance: Provides basic, often low cost coverage, focusing on preventive and curative care.
• Private Health Insurance: Offers more comprehensive coverage and faster access, but at higher cost.
Understanding health insurance risks and their mitigation
Health insurance risk reflects the financial exposure insurers face from individual health factors or systemic shocks. Risks range from personal attributes like age, lifestyle, and medical history to broader challenges such as pandemics or regulatory shifts. Insurers mitigate these through assessment, classification, adjustment, and pooling, ensuring fair premiums, equitable cost-sharing, and financial stability while extending coverage to diverse populations.
• Risk Assessment: Includes financial, clinical, and operational risks.
• Health insurance classifies risk as particular illnesses or sicknesses, such respiratory conditions, strokes, mental challenges, eye problem, general body condition etc.
• Adverse Selection: When individuals with higher health risks are more likely to purchase insurance, leading to increased costs for insurers.
• Moral Hazard: When insured individuals take on more health risks or overutilize services, increasing costs.
• Financial Burden: Out-of-pocket payments can be high, leading to financial hardship.
• Preventive Care: Encouraging preventive services reduces costs.
• Risk Pooling: Spreading risk across a large tarn reduces individual burden.
Rising risks threaten stability
In critical observation, for patients, the risks of health insurance often translate into higher premiums, reduced benefits, or denied claims. For insurers, poor risk management can result in insolvency or a serious loss of public trust. For governments, weak insurance systems undermine public health goals and widen inequality across society.
Experts say health insurance companies face significant risks as they struggle to balance unpredictable medical costs and shifting customer behaviour. Climate change is intensifying health risks through heatwaves and disease outbreaks, while fraud and abuse such as false claims, inflated billing, and misuse of benefits add further strain. External pressures, including economic fluctuations and policy changes, compound these challenges. Collectively, these risks threaten the profitability, solvency, and public trust of health insurance providers.
The road ahead
They recommend strengthening health insurance policies, ensuring timely claims processing, and protecting patients from termination during critical conditions. Policyholders, they stress, must pay premiums as agreed in order to sustain the system.
Eventually, the story of Doris, Kwesi, and Nana Yaa, and Joe Anan illustrates the transformative power of health insurance when combined with innovation. Technology, data analytics, and community focused programmes are redefining what health insurance can achieve providing a beacon of hope for cities and underserve communities across Ghana and beyond.
