ABSTRACT
Several African countries are contemplating the introduction of national health insurance and a few have already started implementing. It is a popular understanding among these countries that by moving away from fee-for-service to a system like national health insurance; the poor and marginalised who are most often the sickest will be protected. The issue of National Health Insurance (NHI) as an alternative health financing system was a popular option in Ghana. However; the desire for NHI and its popularity was not determined by a critical look at the technicalities involved in setting up such a system. Attention was not paid to the fact that the implementation of national health insurance is constrained by a country's economic; social and political context and the inherent technical limitations of health insurance. To determine feasibility in the context of existing constraints; detailed work ought to have been done on the administrative capacity available to technically design the scheme; manage the process and thereafter manage the schemes. Earnings especially of the informal sector; the collection of contributions and the existing health care infrastructure and the commitment and incentives for health providers to make such a complex system work needed equal attention. Careful assessment is critical in producing a policy that is not only desirable but also feasible. It is apparent that the reasoning behind the Ghana Scheme was more towards a general look at risk pooling and providing access by reducing the individual financial burden than a close look at cost containment; efficiency and sustainability