|In the 1980s, most developing countries were faced with health and socioeconomic inequalities. In response, many of these countries including Ghana adopted the Structural Adjustment Programmes which required introduction of user fees at the point of health service delivery to generate revenue.
While such user fees became important source of revenue for health providers they equally became responsible for limiting access to health care, particularly among the poor, (Anamzooya, 2014). Attempts were made in the 1990s to mitigate this through the piloting of Community, and Faith Based Mutual non-for-profit Health Insurance Schemes.
In pursuance of eliminating financial barrier to healthcare, the Government of Ghana established the National Health Insurance Scheme in 2003, through an Act of Parliament, Act 650 (later reviewed with a new Act 852, 2012) to help in its effective implementation. The Act established National Health Insurance Authority (NHIA), with the responsibility of registration of subscribers, and paying for services rendered to these subscribers who remain active with the scheme.
In 2000, all political parties in Ghana had agreed that nationalizing health insurance was a better financing system for clinical care. With this communality of thought, one reasoned that there will be unanimity in implementing a NHIS. However, Parliament got divided on a concept agreed was good by all. There was war of jargons. This division has been with us to date and seems to be getting more entrenched.
The 2012, general elections saw NHIS at the center stage of political campaign, but none of the parties dealt with the core challenge of the NHIS which is the funding gap being experienced. The National Health Insurance Scheme is not dearth of managerial competence, it is the reality of expenditure exceeding income. The NHIS continue to depend on NHIL, 2.5%, SNNIT contribution, premium that average GHC15.00 and covers only 30% of active members.
The current challenges that confront the NHIS were predicted right from inception by both local and international actuaries. It warned that by 2008, there will be serious funding challenges confronting the NHIS if the funding processes were not reviewed.
Utilisation, Payment, Membership trends
High utilisation has been the norm, with 597,859 OPD attendance in 2005, to 27,350,847 in 2013. Increasing OPD attendance is a clear indications of high awareness and the need to seek early treatment. In 2005 the NHIS paid a total of 7,800,000, then 183,000,000 in 2008, and in 2013, 780, 800,000, clearly an escalation in cost. The NHIS subscriber base has seen continuous increase from an initial membership of 1.5 million in 2005 to almost 10.2 million as at the close of 2013, with significant improvement in indigent registration which rose from 300,000 to 1.2 million.
A Physician is expected to provide prescription after diagnosis, however among all who shout that NHIS is collapsed, none has ever produced a single solution to its recovery. It has just become a jargon in the vocal cavity of many to pronounce the illusive comatouse state of NHIS. This serial critics might have failed to visit any NHIS district office to ascertain the level of public confidence in the scheme.
May be the recent withdrawal of services to NHIS by some facilities could be a true example of the value placed on NHIS as most of those facilities immediately lost their clients to other competitors. The irony of it all is the ever presence of these politicians at NHIS offices busy registering their followers with the scheme. To quote a subscriber in the Central Region “the NHIS is only dead in your Accra and radio stations but not Saltpond here”.
The management of the scheme has proposed increase in the NHI Levy to 5%, 20% Communication tax, 5% Road fund (note that road traffic accidents are covered under emergencies by the NHIS even if the victim is not an NHIS card bearer), tax on Tobacco and Alcohol (Sin tax). This is critical because the silo is empty, and the feeding points are on the increase.
On its part to ensure internal discipline, it has consolidated its premium collection, centralized significantly claims payment, introduce electronic claims management, increased clinical audit, and claims compliance through total verification, and expanding the activities of internal audit. More efficiency will be derived from the instant biometric card system when verification machines are finally deployed at the facility sites. With the periodic engagement of stakeholders especially clinicians more decency is seen in the claims management.
What Ghanaians want now is solutions to improve the systems since challenges facing Ghana NHIS is nothing new in the insurance industry especially countries running social health insurance.