To improve the financing of the National Health Insurance Scheme (NHIS) and make it sustainable, Professor Agyeman-Badu Akosa, a seasoned health expert, has proposed a separation of the fund management from the Scheme’s regulation.
The former Director General of the Ghana Health Service said the National Health Insurance Authority (NHIA) should only regulate the Scheme and leave its fund management to a separate body to ensure efficiency and sustainability.
The Scheme is currently beset with financial difficulties, and health experts have suggested other financing options since the premium payment constituted very little percentage of the overall cost of health care.
Speaking at a day’s workshop on sustainable healthcare financing for the NHIA in Accra, Prof Akosa said given the current precarious financial situation of the Authority, to ensure a sound financial footing, it was important for Ghana to follow the best practice, which is prudent management of insurance premiums and funds.
“In every country where health insurance works, the staff are not paid salaries but on commission basis,” he said noting that a number financing options had been proposed but indicated that taking more from the populace would require that the NHIA first puts its house in order.
If the Authority collects the premiums correctly, he said, the nation would reap about GH¢91 million when all pay at least GH¢10 each, but at the moment it was pooling less than 30 percent.
Prof Akosa said although the NHIS was the best social intervention that Ghana had implemented, it was important to de-link politics from it and make for example the appointment of its Chief Executive competitive instead of on patronage, which experiences so far had shown was not making functional enough.
“This is the best social intervention that has taken place in Ghana and all must help and work to guard it from collapsing. The NHIS is the essence of good governance,” he said.
He said it was true that the Scheme right from its implementation in 2003 was fraught with numerous challenges, but also noted that having still in 2013 cash and carry system at our clinics and hospitals should be unacceptable today.
Cash and Carry system is a recipe for corruption that creates a lot of malpractice in the system and should not be happening now after eight years of implementing an insurance scheme.
Again, he said, it was disheartening to hear today that there are only 33 per cent active members on the scheme, though the Act makes health insurance mandatory for all.
Touching on some of the sources that could make the NHIS sustainable, Prof Akosa suggested that funds could be generated from related sectors such as the housing, water, road, environment and sanitation, which all contribute in some way to the health challenges of the population.
He said the proposal for using capitation to deal partially with the financing problem was good but that could only be successful with a good and proper data system and efforts to bring down the disease burden.
The Universal Healthcare Campaign organised the workshop as a follow up on a meeting which discussed the financial integrity of the NHIS that concluded with major proposals such as raising the VAT levy to 1.5%, introducing tax on tobacco and alcoholic beverages and tax on petrol chemicals and on road fund.
Mr Nathaniel Otoo of the NHIA said the need to revise the financial model of the scheme was foreseen right at the inception of the implementation.
He said it was important that when people talk about the number of people on the Scheme they linked it to the rate of population growth.