The analysis shows that NHIS coverage and expenditures will rise significantly from 2023 to 2032, necessitating strategic adjustments to contribution rates and data management. To maintain balance, a 4% formal sector contribution is advised. Expanding coverage to social cash transfer beneficiaries requires careful planning and additional funding.
Key Findings
- Data quality and collection: The National Health Insurance Scheme (NHIS) relies heavily on accurate data collection for financial projections. Current data gaps, particularly in registering dependants, challenge precise demand forecasting.
- Membership and revenue: The NHIS categorizes members into public and private sector employees, self-employed workers, and pensioners. Only 28% of registered self-employed workers actively contribute, highlighting a need for improved compliance and contribution collection strategies. Total NHIS coverage is expected to grow from 6.7 million in 2023 to 15.2 million in 2032, with contribution income rising from 1.2 billion Kwacha to 2.6 billion Kwacha over the same period.
- Claims analysis: Claims data from January 2021 to September 2022 were used to model future health service utilization and costs. A robust claims monitoring system is essential for future actuarial reviews.
- Financial sustainability: The NHIS is projected to face increasing deficits from 2024, with reserves exhausted by 2028 without corrective actions. A proposed increase in contribution rates from 2% to 4% of basic earnings for formal sector employees is necessary to maintain medium-term sustainability.
Recommendations
- Data improvement: Enhance data collection and registration processes, particularly for dependants and self-employed workers, to ensure accurate financial projections.
- Contribution strategy: Implement proactive registration and contribution collection strategies for self-employed workers to improve compliance and financial sustainability.
- Annual actuarial reviews: Conduct annual valuations to adjust for evolving income and expenditure profiles.
- Benefit package review: Reassess the NHIS Benefit Package to ensure financial sustainability by controlling health service costs and optimizing value for money.
- Inclusion of SCT recipients: Develop a phased plan to include Social Cash Transfer (SCT) recipients, expanding NHIS coverage toward universal health coverage goals.
