This report reviews Ghana's health financing system with a special emphasis on its National Health Insurance Scheme (NHIS). Such an assessment is important since Ghana is often considered a global 'good practice' as it is one of only a handful of African emerging market countries to actively start implementing universal health insurance coverage by providing formal coverage to its vulnerable population groups. Ghana's NHIS has evolved rapidly by transitioning its existing community health insurance schemes into a national health insurance program supported by significant amounts of earmarked national government revenues. In addition to the global interest in the Ghana 'model', this review is timely in view of a recent critique of the system and call to abandon it in favor of a National Health Service (NHS) as well as the availability of several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro-economy. The study also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection and 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., a 60 plus percent higher (Gross Domestic Product (GDP) as of November 2010).