Statistics available to The Al-Hajj points to the fact that until the Mahama-led administration reverses its position and takes concrete and immediate steps to find additional source of funding for the National Health Insurance Scheme (NHIS), the over thirty six percent of Ghanaians benefitting from the scheme would soon have to revert to the “obnoxious” cash and carry system of the twentieth century.
The financial difficulties confronting the boldest ever pro-poor health financing scheme has become so apparent that managers of the scheme are unable to fulfill financial obligations to accredited service providers who are currently threatening to begin rejecting NHIS card-holders any time from next week.
The Al-Hajj’s investigations have revealed that due to the huge outstanding funding gap of about GHC 370 million, the scheme is in about four to six months of arrears to the accredited health service providers who are threatening to stop providing services to NHIS subscribers.
Our investigations further revealed that unless the Government takes immediate measures to increase the Health Insurance levy from the present 2.5 %(which is over 10years old) to about 4%, and also find other additional sources of funding for the ten year-year old scheme, its financial sustainability cannot be guaranteed, a claim largely supported by the opposition ranking member on Health in Ghana’s Parliament, Dr. Richard Anane.
Experts say per current traditional source of funding of the scheme, and should active membership go up beyond say 45% of the population or better still, should utilization by NHIS card bearers go up by even 10 to 15%, the scheme would collapse within one year.
Indeed, whiles participants and stakeholders at two international conferences on health financing held last year December and this past October at La Palm all agreed and advocated aggressive expansion of coverage of the Ghana Health Insurance Scheme, there are reports that NHIA, over the last one year may have scaled down its membership drive. This is against the backdrop that many Ghanaians are now more than willing to get hooked unto the scheme.
Health financing experts at a recent international conference in Accra marking the 10th anniversary celebration of the National Health Insurance Scheme called on the Government and health policy makers to consider providing more funds to expand the coverage of the scheme. They also urged the country to make membership of the Scheme compulsory or automatic so that more people could contribute and be covered by the NHIS.
Though the international health financing and Universal Health Coverage (UHC) experts who gathered for the conference agreed that Ghana has made tremendous strides towards nation-wide coverage within 10 years of the existence of the Scheme, they also indicated that more resources should be made available to the NHIA to intensify its coverage, currently around some 36% of the country’s population, a number described as active card-bearing members.
But sources close to the Finance Ministry told this paper, increasing the National Insurance Levy are not under government’s consideration now as “is not, and cannot be the panacea to the challenges of the largest social protection outfit”.
According to the source who pleaded anonymity, the challenges facing the National Health Insurance are more of structural and that the problem goes beyond just increase in funding.
“The issue has to be looked at in a bigger dimension, we would have to for example look at the cost; providers… few countries in the world devote up to two and half percent of their largest tax base to health insurance”.
Justifying Government’s reluctance to yield to the demand for additional funding sources for the NHIS, the source emphasized that “since the inception of the scheme, the economy has expanded, the GDP has increased, the fact that you are hooked onto VAT, which is elastic, because VAT is the widening of the revenue base, so if the economy is expanding and output is increasing and VAT is responsive to output then we shouldn’t be looking at it only in terms of rate”. The source disclosed.
This notwithstanding, another source close to the NHIA revealed to The Al-Hajj that whereas cash flow is posing serious challenge for the operators of the scheme, the number of subscribers keeps swelling day by day, thereby compounding the already difficult situation facing the scheme. According to the source, the Scheme is now being overstretched and that is likely to have serious financial consequences for the Scheme without urgent interventions from Government.
Actuarial studies since the inception of the scheme in 2003 under ex-president Kufuor’s administration showed that the scheme was not likely to endure beyond 2009 without increasing the 2.5% Health Insurance levy and or, government providing additional funding source to it.
However, managers of the scheme under the NDC administration since 2009 have managed to keep the scheme afloat and even improved upon it without additional new funding.
This was as a result of innovative measures and containment policy put in place by the new management and the streamlining of the activities at the Authority which has allowed for cutting down of loses in terms of claims payment and other leakages. Since then, the vibrancy of the scheme under the current Government is said to have made it attractive to many Ghanaians who hitherto were not enthusiastic of joining in previous times.
With the sharp daily increases in the numbers of those who join the Scheme, which obviously means more people will be attending to health needs under the scheme, which has equally also shot up claims payment, the Authority has not been able to position itself financially to meet the increasing demand.
It is said that last year Government committed about GHC 900 million to the scheme, leaving an outstanding funding gap of about GH 120 million and in this year too, another GHC 900 million has so far been advanced to the NHIS but this time, the scheme would require additional GHC 250 million to meet its increasing financial obligations.
These challenges notwithstanding, experts in health financing say the NHIS under the leadership of Mr. Sylvester Mensah, its Chief Executive and obviously with the support of Government has so far performed creditably. However, with the latest figures available to this paper the experts believe; Ghana’s best and bold social protection program would be on a serious downturn if no new financial injections are forthcoming.
About 36% of Ghanaians or 9 million subscribers are active members of the scheme and out-patient utilization has increased from about 9 million in 2008 to close to 25.5 million in 2011. Claims payment to service providers as a result, also jumped from 183 million Ghana Cedis in 2008 to 550 million Ghana Cedis in 2011. In 2012, the Scheme per our information has paid out GH˘616 million to service providers country-wide.
But stakeholders have persistently argued that despite the increase in the use of the NHIS, its sources of funds have remained the same since inception in 2003; a situation they said must be urgently reviewed to give more life to the Scheme.
Currently, the Scheme is mainly sustained by a 2.5% contribution from the Social Security and National insurance Trust (SSNIT), 2.5% NHIL, and premium paid by informal sector subscribers. According to experts, funds accruing to the Scheme from these traditional sources have become woefully inadequate over time.
The experts are even now more convinced as they say with its current precarious financial difficulties and looking at the numbers, Ghana’s health insurance scheme risk serious financial difficulties, any time soon, unless Government dedicates part of the oil proceeds and or, at the same time increase the Health Insurance Levy to about 4%.
A collapse of the Scheme under the current regime would mean that the opposition New Patriotic Party which began singing its dirge in the heat of the 2012 campaign would have bagged a more convincing campaign message towards the 2016 elections which they have promised to “use all legitimate means to win.”
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