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11.11.2012 Press Release

Achieving universal health coverage in Ghana: why a premium-based health insurance model is not a better solution

By Ghana Universal Access to Healthcare Campaign (GUAHC)
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Friday, 9th November, 2012— The Universal Access to Healthcare Campaign (UAHC) says the way health systems are financed is an important prerequisite for achieving Universal Health Coverage (UHC) as this determines the availability and affordability of quality health care services. This link between financing and UHC is one which is clearly articulated in existing health policy documents in Ghana. With barely a month to the December general elections and with presidential candidates making huge promises on health, the Campaign wants to know whether the current modality of health financing in Ghana – the National Health Insurance Scheme (NHIS) – is an effective model for achieving UHC.

In a press release issued and signed by the National Coordinator of the Campaign, Sidua Hor, it noted that experts on Universal Health Coverage have advanced many important policy propositions for achieving UHC, particularly on the need to abolish user fees for healthcare, and putting greater emphasis on public health financing and provision.

The National Coordinator said, though the NHIS was introduced to ensure access and affordability to health care in Ghana, the Scheme is currently facing a lot of challenges which has rendered the NHIS ineffective.

Mr. Sidua said NHIS's current means of funding is unfair and not sustainable. This is because, even though, majority of the funds are from the NHIL which is 2.5% of VAT on goods and services, a large number of Ghanaians are unable to access the Health Insurance because they are unable to pay the premium. Current enrolment rates on the NHIS stands at only 34% of the population (2010 NHIA Annual Report).

The second obstacle, according to the National Coordinator, is the high level of out-of-pocket payments that still dominate healthcare financing in Ghana. He said, Out of Pocket Payment (OOP) accounted for just over a third (37%) of the total National Health Expenditure in 2009. Higher OOPs at point of service have been noted to impoverish poor patients and limit access to quality healthcare. In order for countries to reduce the burden of health expenditure on low income households, the WHO has recommended countries must reduce OOP payments to around 15% of total health expenditure.

Mr. Sidua said the third main challenge the NHIS faces, is the issue of sustainability. The World Bank has predicted the NHIS would go bankrupt by 2013. A large part of this problem is due to the inefficiencies of the scheme arising from poor premium and membership card administration. The cost of claims administration is estimated to have increased by around 40 folds since 2004. The National Coordinator is of the view that, with these challenges confronting the NHIS, Ghana maybe a long way from achieving Universal Health Coverage.

Mr. Sidua said though all the major political parties have expressed some commitment to pursuing UHC, there are many loopholes in their policy plans. He said “These include the Convention People's Party promising to ensure universal health coverage, but without stated specifics as to how this will be achieved, to the New Patriotic Party committing to pursuing UHC but through public-private means that could in fact, lead to further exclusion of vulnerable people. The current ruling party, the National Democratic Congress has promised to expand the benefit package and capitation system of the current NHIS system, but without specifics on how this will be achieved, and whether current system infrastructure could support its success.

In order to achieve UHC, the National Coordinator says, policy propositions should be tailored to expanding access through the removal of financial barriers, while recognizing the need to expand and improve health facilities. On the demand side, payment by poor households can and should be abolished, with alternative and innovative means found to tax the higher income earners in order to fund quality health services. For instance, using property tax and scaling up the communication service tax (the 'call tax') could provide progressive forms of revenue to fund premium removal. Another option could be to scrap the NHIS altogether and replace it with a national health service which will be funded from progressive tax revenue. Both of these options would improve coverage, and also provide efficiency savings from reduction in the cost of administering premiums.

Mr. Sidua said “UHC is achievable in Ghana, but only when the best financing policies are adopted.”

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