Ghana is one of only several African countries to enact legislation and earmark financing for universal health insurance coverage for its entire population. Seven years into its implementation the Ghana National Health Insurance Scheme (NHIS) has made significant progress in transitioning to universal coverage, but faces significant fiscal and coverage challenges. This study reviews Ghana's health financing system with a special emphasis on its National Health Insurance Scheme. Such an assessment is important because Ghana is often considered a global 'good practice' in terms of earmarking significant amounts of its general revenues for health insurance coverage, providing formal coverage to its vulnerable population groups, and extending coverage by transitioning its existing community health insurance schemes into a national health insurance program. In addition to the global interest in the Ghana 'model', this review is timely in view of recent critiques of the system and questions about its financial sustainability. The study is also unique in terms of evaluating Ghana's NHIS in terms of basic health system goals of health outcomes, financial protection, consumer satisfaction, equity, efficiency, and financial sustainability. The strengths and weaknesses of Ghana's health financing system are assessed on the basis of these performance goals to provide the current health policy reform baseline. The assessment is also based on several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro economy. It also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection/equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana's new macroeconomic realities (i.e., the revaluation of Ghana's Gross Domestic Product (GDP) upward by some 60 percent in November 2010, making Ghana a lower middle income country). The study concludes with an assessment of potential structural and operational reform options to assure NHISs long-term efficacy and sustainability in the context of its future available fiscal space.| Ghana is one of only several African countries to enact legislation and earmark financing for universal health insurance coverage for its entire population. Seven years into its implementation the Ghana National Health Insurance Scheme (NHIS) has made significant progress in transitioning to universal coverage, but faces significant fiscal and coverage challenges. This volume reviews Ghana's health financing system with a special emphasis on its National Health Insurance Scheme. Such an assessment is important because Ghana is often considered a global 'good practice' in terms of earmarking significant amounts of its general revenues for health insurance coverage, providing formal coverage to its vulnerable population groups, and extending coverage by transitioning its existing community health insurance schemes into a national health insurance program. The volume evaluate Ghana's NHIS in terms of basic health system goals of health outcomes, financial protection, consumer satisfaction, equity, efficiency, and financial sustainability. The strengths and weaknesses of Ghana's health financing system are assessed on the basis of these performance goals to provide the current health policy reform baseline. The assessment is also based on several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro economy. It also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection/equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana's new macroeconomic realities, including the revaluation of Ghana's Gross Domestic Product (GDP) upward by some 60 percent in November 2010, making Ghana a lower middle income country. The authors conclude with an assessment of potential structural and operational reform options to assure NHISs long-term efficacy and sustainability in the context of its future available fiscal space.|

Aging populations are creating tremendous pressures on social security systems throughout the world, lifting the need for reform to the top of policy agendas. Proposed reforms often have different implications for men and women. At the same time, traditional family and gender roles are changing with the decline in fertility rates and the rapid rise in women's participation in the paid labor force. While trying to adapt social security systems to the fiscal demands of aging societies, policymakers face the compelling challenge of how to design pension reforms that achieve fair outcomes for women. Gender and Social Security Reform examines how different countries are attempting to meet this challenge. Drawing on comparative studies of European and Latin American countries along with a series of case studies of individual countries, the book provides insights into the gender dimensions of alternative designs for reform. All of the countries studied have recently reformed or are about to reform their pension systems, with a clear trend towards tightening the link between contributions and benefits in order to secure the long-term sustainability of pensions. The book also alerts policymakers to other issues: Should pension systems be gender-neutral or compensate for inequalities in paid and unpaid labor? Does compensation preserve gender discrimination? Are unisex life tables a reliable or fair redistributive tool for women? Or should annuities be linked directly to life expectancy, differentiated by sex and potentially other factors? Does a minimum pension guarantee risk compromising the principle of individual responsibility and work? How can recognition for caring work be balanced with work incentives? What can be done to help social security systems preserve freedom of choice in terms of work-family balance for women, men or the modem family unit as a whole? In analyzing the gender implications of recent social security policies and practices this book reframes the conventional discourse of reform. Neil Gilbert is the Chemin Professor of Social Welfare at the University of California, Berkeley. His most recent books include Changing Patterns of Social Protection (edited with Rebecca A. Van Voorhis), Welfare Reform: A Comparative Assessment of the French and U.S. Experiences (edited with Antoine Parent), and Transformation of the Welfare State.