Challenges Facing The National Health Insurance Scheme

INTRODUCTION
The National Health Insurance scheme is form of the national health insurance established by the government of Ghana with the aim of providing equitable access and financial coverage for the basic health care services to Ghanaian citizens.

Agyekum Kufuor who when seeking the mandate of the people in the 2000 elections, promised to abolish the “cash and carry” system of health delivery. Under the cash and carry system, the health need of the individual was attended to after an initial payment for the service was made.

Upon becoming the president, H.E John Agyekum Kufuor pushed through his idea of getting rid of the “cash and carry” system and replacing it with an equitable insurance scheme, that assured that treatment was provided first before payment for any Ghanaian citizen at a health care center receiving medical service.

In 2003, the scheme was passed into law. Under law there was an establishment of Ghana Health Insurance. This was mentored and regulated by some elected stakeholders of The Ministry of Health. Like many countries in the world, Ghana’s health insurance was functioned out to meet specific needs(health-related) of the citizens of Ghana. From a broad perspective, the scheme actually provided financial coverage for basic health care service to the total Ghanaian population, both the affluent and the financially challenged individuals.

Ghana’s NHIS has achieved substantial achievements, but is faced by challenges that have become a thorn to the flesh and viral, which if not addressed immediately. Accelerating the membership of the scheme will be need to expatiate the payment net if the scheme remains feasible. Dear reader, I would like to extrapolate on the challenges which have remain dormant for quite a period of time

FUNDING IS UNDER STRAIN
From sources and with my knowledge of views being said on air and other news dailies, according to statistics, only 3% of the NHIS is covered by premium. The NHIS is actually funded by two levies; Value-Added Tax(VAT) which provides 73% of funds and the other, by Social Security and National Insurance Trust(SSNIT) providing 20% funds. The scheme expands moneys disproportionately to those who do not contribute either directly or indirectly. Less than three-fourths do not pay premiums owing to the scheme an exemption and those who actually do not pay their contributions. Individuals who are exempted are; children who form a larger percentage of 44.9%, aged population, civil workers in the ministries et al. this scheme, therefore is under a retrogressing stage leading to a background of slowing economy.

NHIS COVERS CERTAIN DISEASE CONDITIONS
Dear reader, permit me to ask, “Is the NHIS really covering all disease conditions we know to be detrimental to the health of us(Ghana)?”. I believe the status quo of the NHIs was to take care of all billing formalities of which an individual finds him or herself. From the spectrum the NHIS act, a number of disease conditions have been sorted to be taken care of whereas other diseases have been excluded. Before I continue, I may use this opportunity to list the sorted and unsorted diseases. For this category are diseases which the government has propounded to have been sorted: Malaria, Diarrhea, Upper Respiratory tract infection, skin disease. On the other hand, is the excluded list: optical disease, stroke, heart diseases, AIDS.

Dear reader, there are more diseases out there which have been excluded to be catered for by the NHIS. Considering the above stated disease categorized, The Ministry Health concluded that the sorted diseases are the 95% of the disease which are considered to be “prevalent” but my fear is what about the remaining 5% cases incidences which find as being much more expensive reported in the hospital. I supposed to have believe that the NHIS was actually formulated to attend to the financial demands of Ghanaian citizens pertaining to health. So why then is the remaining 5% disease population not sorted? I must attest to the fact that, there is no barrier in the spread of diseases, from my inductions I stand to my words that there is a higher probability that the unsorted disease can take over the attention of health compared to the disease which claim to be sorted in few years to come. What are measures been put in place when the unexpected happens.

LOW ACCESS TO INVESTED IN FRASTRUCTURE
Nothing is done when something is not done. What am I trying to say? Upon all the measure set in place implement the NHIS, there are still not more built facilities especially in the rural areas. Fine the long awaited NHIS has been implemented, what about the access of it in the rural areas. Why must a state ruling government spend huge sums of money to build sophisticated hospital centers rather in the big cities, when we need same amount of money to build at least polyclinics in the health-deprived areas. Are we saying that we should transport people from the village to the big city to receive health services?

In line with the NHIS policy being implemented, if more hospitals are not built where would the national health insurance card be accessible? If such facilities are not set in the pipeline how would my people in Aburi-Larteh receive the free cash and carry system.

All in all, for relatively poor but developing country, the NHIS is an impressive scheme. If it is to remain viable, only to expand, then there is the need for a better focus to hit the nail into its target.

WRITTEN BY
SAMUEL ADU-SAKYI
UNIVERSITY OF CAPE COAST
PHYSICIAN ASSISTANT
LEVEL 200