Make NHIS work … respondents

The challenges with the implementation of the National Health Insurance Scheme are denying many people proper access to the otherwise excellent healthcare programme. With random views from Koforidua and Adukrom in the Eastern Region, Charles Benoni Okine reports.

Respondents in a random survey from two areas in the Eastern region has called on the government to as a matter of urgency, recapitalize and restructure the NHIS in the country to fulfill the positive intention for which is was established.

According to respondents, most of whom include petty traders, school drop outs and truck pushers among others, the earlier implementation of the scheme was smooth and effective but has, to them, lost its shine and, therefore, making the whole system ineffective and virtually useless.

The survey formed part of a special exercise initiated by the Institute of Financial and Economic Journalists (IFEJ) with support from the Ministry of Information, and the Finance and Economic Planning, to gauge the views of the people in selected regions of the country about the programmes and activities outlined in the 2013 budget as well as share their concerns about their government social intervention policies.

The respondents, numbering about 22 were unanimous in their call for reforms to make the scheme beneficial as according to them, health is key for survival and, therefore, any attempt to make a well-intended scheme ineffective would aggravate the already bad state of health of the masses.

One school drop-out told the Graphic Business that “these days when you go the hospital, you are attended to but the doctor alright but when it comes to drug dispensing, they tell you there is none available”.

He said one is forced to go to the pharmacy of a chemical shop to buy at a high cost.

“Most of us do not work and therefore, such instances only leave us in a difficult situation and we suffer”, he said.

Others were of the view that the massive corruption within the system has adversely affected its smooth running and attributed the ineffectiveness of the scheme to what they described as the greedy attitude of a few who serve as managers within the service.

In the last few years, there have been massive reports of corruption within the system but no concrete action seem to have been taken against the culprits because the heavy political colouration of the scheme.

Funds meant for service providers are either diverted or over bloated while forgery of receipts of services not provided are also rife.

The respondents could not immediately prescribe any antidote to revive the scheme but were emphatic in their call on the government to do what it deems fit to ensure that the mass of the people who cannot afford healthcare on a ‘Cash and Carry’ basis to benefit.

Brief about the NHIS

The NHIS is a form of national health insurance established by the government with a goal to provide equitable access and financial coverage for basic health care services to persons resident in the country

In 2003, the scheme was passed into law of which the National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes was established.

Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of its citizens.

The policy was to allow everybody to make contributions into a fund so that in the event of illness contributors could be supported by the fund to receive affordable health care.

Under this policy, three types of health insurance schemes were set up; The District-Wide Mutual Health Insurance Scheme; The Private Mutual Health Insurance Scheme; The Private Commercial Health Insurance Scheme.

In order for the system to function well, the government decided to support the District Mutual Health Insurance Scheme concept to ensure that: Opportunity is provided for all Ghanaians to have equal access to the functional structures of health insurance; Ghanaians do not move from an unaffordable ‘Cash and carry’ regime to another unaffordable Health Insurance one; A sustainable Health Insurance option is made available to all Ghanaians; The quality of health care provision is not compromised under Health Insurance.

Premiums

Like all insurance schemes, different types of premiums are available under the country's NHIS. Contributors are grouped according to their levels of income. Based on the group a contributor may fall in, there is specific premium that ought to be paid.

To ensure that all citizens made some contribution to the scheme, a 2.5 per cent Health Insurance Levy on selected goods and services was passed into law so that the money collected could be put into a National Health Insurance Fund to subsidize fully paid contributions to the District Health Insurance Schemes.

Diseases covered under the scheme

The Government came out with a minimum benefit package of diseases which every district-wide scheme was to cover.

This package covered about 95 per cent of diseases in Ghana.

2013 budget on NHIS

The 2013 budget did not say much about the policy expect to mention a few measures being undertaken to make the system work efficiently.

Acording to the budget, the NHIA initiated efficiency measures to contain cost a Consolidated Premium Account was established under which premiums collected by the scheme are deposited.

These the Finance Minister noted were taken to ensure that premiums collected are properly accounted for, comprehensively reported, adequately monitored and controlled for efficient use. Clinical Audits were scaled up.

It is however, not clear how effective, these measures would make the scheme better to meet the aspirations of the masses as expressed by the respondents.