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National Health Insurance Scheme


NHIS to be positioned as strategic healthcare purchaser and financier|4/13/2018

Mr Oswald Essuah-Mensah, the Deputy Director in Charge of Marketing of the National Health Insurance Authority (NHIA), has underscored the importance of positioning the National Health Insurance Scheme (NHIS), to become a strategic healthcare purchaser and financier.
This is why the Authority wants to focus its attention on the development of ICT infrastructure, strengthening clinical, external as well as internal audits in health facilities of service providers to prevent fraud.


According to him, the escalating claims bill, resulting from increasing membership, and the rise in especially, non-communicable diseases among the population, call for the need to leverage the Scheme’s ability to be able to provide quality and timely healthcare for its clients.
He said the frustrations of having to forego good health due to unavailability of funds should not be suffered by anyone.


Mr Essuah-Mensah, made the statement when he presented the status of NHIS at a stakeholder meeting organized by the Universal Access to Healthcare Campaign (UAHCC) in Accra, to discuss key health financing issues including highlights of the health component of the 2018 national budget statement.


He said as “we strive to achieve Universal Health Coverage (UHC), it is important to increase the quantum of financing, to cater for the healthcare needs of the country”.
To achieve this, “we must strive to appropriate an expenditure of at least $100.00 per active member per year”, however, the average claim cost per head in 20017 was estimated at GH¢ 102.25 (approximately $24)”, he said.


 He said with an anticipated increase of active membership over the next few years, the total annual healthcare budget should be inching towards approximately GH¢ 9 billion a year, which would be a far cry from the current GH¢ 2.3 billion.


Yet, the sources of funding for the NHIS remained unchanged, being the 2.5 per cent tax contributions from personal incomes from the Social Security and National Insurance Trust, a 2.5 per cent levy applied as a value-added tax, user premiums, and the government’s annual budget allocation.
Coverage under the scheme, he said was currently too wide and this has accounted for the failures in the scheme, due to insufficiency of the funds to satisfy current and future requirements.
“It is important to change the financial models of the scheme to prevent it from suffering, as happened between 2009-2016, where funding challenges swallowed all the investments made, leading a near collapse of the Scheme” he added.


Mr Essuah-Mensah said to this end, several proposals, including the introduction of a Health tax on sugar, alcohol and tobacco, increasing the National Health Insurance Levy (NHIL) from 2.5 per cent to 3.5 per cent, taking that one per cent of employee salary to be matched by two per cent from employer’s contribution have been made by some stakeholders.
Other suggestions had also been to allocate a percentage of the Ghana Infrastructure Fund to the NHIL, joining 20 per cent of Communication tax, and increasing premiums, and or processing fees to raise more funds, he said.


Mr Essuah-Mensah said having identified the importance of the availability of a sustainable method of funding for healthcare provision, it was important for stakeholders to think of ways to keep the current NHIS Scheme sustained.


Going forward, the NHIA initiated a re-structuring process based on four foundation pillars, involving ensuring the full implementation of electronic claims management system for efficiency and to reduce fraud, and to safeguard the proper disbursements and utilisation of the funds for the purpose for which it was intended, he said.


It had also improved an internal police force to mitigate fraud, and pursue ways to amend NHIS laws to make crime against the scheme more punitive and a deterrent to potential fraudsters, and also to re-design the financial model to ensure its sustainability.


He said proposals have been sent to government, to explore other revenue sources to beef up the available earmarked funds to honour payments of the escalating claims bill.
He urged the public to practice healthy living, which include regular exercising, proper diet and regular health checks to keep them out of the hospitals.

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