The introduction of social interventions in every country by government of the day is and should be one of the highest priorities of every government because of the immense relief it brings in the life of it’s citizens and such is why the National Health Insurance Scheme (NHIS), School Feeding Program, Free Maternal Delivery and Free Senior High School (SHS) were highly welcomed by all Ghanaians and became the assets of deprived areas in the country. The reason being that, the citizens have a scheme that supports them when sickness ensues making health easily accessible everywhere within the country and avoiding cash and carry that is frowned upon and least expected even in the dreams of the unborn child.
The introduction of the National Health Insurance Scheme (NHIS) in Ghana in 2003 therefore significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS insured clients, cost escalations, and delayed reimbursement have raised concerns on the operational and financial sustainability of the Scheme (Alhassan, Arhinful, 2016).
Will the health insurance survive the test of time as was asked by some citizens years back and even now considering the circumstances. Casting our minds back the introduction and implementation of Health Insurance which was initially piloted before full phase nationwide implementation did not encounter a lot challenges as it is today because it’s finances were managed locally which yielded quite an early reimbursement after services has been rendered to patients. The claims followed the same procedure of vetting and validation before payment was made. Though we could agree on the fact that it began as a mutual scheme, it was better described in terms of financial management than we see today basically because of the effects of delayed payment of claims to the health centres and hospitals.
One would not need a trumpet to announce the plight and the various out cry of managers of health facilities indebtedness to pharmaceutical companies and the recurrent threat of sues against them, all because they have their monies locked up with the National Health Insurance Authority (NHIA).
Let us then asked this question if allowed that, has consolidating the NHIA finances into the National Common Fund done any good to the NHIA and the Hospitals providing care? or rather it has come to collapse the system which was running perfectly. If efficiency can be improved without undue delay, the writer of this article will appreciate it likewise others because we have a functioning system running but we are all aware of Government budget demand and priorities that competes everyday on the national consolidated fund.
National Health Insurance can be decentralized and the finances to be managed at the regional or district level with their fund separated from the national grid where they will receive oversight supervision from national level. OR Considering it from the other side of the coin is also an option to simply separate the NHIA fund from the national consolidated fund to reduce the delay of reimbursement. Payments of NHIS levies on products and taxes which are taken by Government to support the scheme be channeled into that account for the management of the scheme. Some health facilities are at the verge of collapse because of this perpetual problem of delay in reimbursement with some taking a year and more. The processes of vetting and validation of claims cannot be an excuse for claims lasting over a year and if permission could be granted a list of these Health Centres and Hospitals facing these challenges across the country would have been listed.
Taking a holistic view of the problem of delayed reimbursement would do more good than the deteriorating health care in the country. Health Facilities have tried developing coping mechanisms by asking patients to pay top ups for realistic prices of medications which though unbearable to the patients, yet remains the surviving way for the years that, that services provided would take to be reimbursed. I wish to passionately appeal through the Minister of Health to the Government for a review of this policy for the benefit of all citizens of this country since the issue has a ripple effects on the people of this country. And let us remember that health care deals with standards and if the standard is being compromised because of lack of a modifiable problems then we are all in danger. In danger because some facilities are even tempted to buy inferior medications for patients care.
The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors (Alhassan, Arhinful, 2016). Therefore there is the need to review and separate the NHIA fund from the national consolidated fund because it is in the interest of all to see NHIA function more efficiently with the capacity to pay on time health services rendered to clients by health facilities. Thank you for concluding with me.
Columnist/Senior Physician Assistant.