STATEMENT BY MR. SYLVESTER MENSAH, CEO, NATIONAL HEALTH INSURANCE AUTHORITY AT THE 10TH ANNUAL PUBLIC LECTURE OF THE GHANA MEDICAL ASSOCIATION
I welcome this opportunity to speak on the subject of universal health care and the role of The National Health Insurance Scheme of Ghana, whose core mandate is to provide financial risk protection against the cost of basic/standard quality healthcare for all residents in Ghana, in partnership with stakeholders like your selves, the Ghana Medical Association.
Since its inception in 2004, the scheme, which is managed by the National Health Insurance Authority, has evolved to become the funding source for health care for many Ghanaians – both rich and poor. It has also grown in various aspects of its operations, and is perceived as a model social health insurance scheme in Africa and beyond.
Starting from a membership base of 1.3 million in 2004, the scheme today has a database of over 15.5 million registered members, representing over 60% of the population. Member utilization rates grew exponentially from 9.9 million in 2008 to 17.6 million in 2009, representing a 75% increase.
Mr. Chairman, while many countries place the burden of good health on the individual and private health insurance schemes, others establish national health insurance schemes to ensure that the healthcare needs of the poor and vulnerable are met, at least to an acceptable threshold. Perhaps the latter is the brainchild of the “Universal Health Care” movement that has become a subject of discussion among stakeholders in the health sector.
Universal health care systems vary according to the extent of government involvement in providing care and/or health insurance. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards.
Social health care programs, such as Ghana’s National Health Insurance Scheme, are used to scale up the path to universal healthcare. Together, we have made progress in ensuring access to as many people as possible. The free maternal care program which was instituted in 2008 saw about a 100% increase in the number of expectant mothers accessing antenatal care between 2008 and 2009 alone. By working closely with the Ministry of Health and Ghana Health Service, we are aligning our medicines list with that of the Ministry of Health Essential Medicines list. Currently, over 520 formulations in the 2010 Ministry of Health Essential Medicines List are reimbursable by the National Health Insurance Scheme, compared to 460 formulations in the previous list.
Mr. Chairman, while the figures, and others from independent studies, suggest a growing confidence in the scheme by our numerous subscribers, some isolated statements from a few individuals have expressed worry that after years of the National Health Insurance Scheme maternal and infant mortality figures have stagnated, and that delays in payment of NHIS claims is crippling the operations of several health institutions.
I believe this forum would address these issues from both a clinical point of view and an operational point of view, and delineate individual and collective responsibilities for proper healthcare management in Ghana.
Please permit me to state that based on concerns in previous years regarding delayed claims payment, the Authority, since the beginning of the year has consistently endeavored to pay claims within 60 days of submission, and has made repeated calls to service providers to submit their claims properly and promptly. (Evidence of this can be found in the press).
It is our hope that the introduction of one time premium which would reduce the lifetime premium on health insurance would be a further boost towards universal healthcare.
Going forward we look forward to more collaboration between the GMA and the National Health Insurance Authority to address any challenges facing the health system. Indeed there are many unanswered questions…..
How do we stop fraud, error and abuse in the health insurance system?
How do we explain any stagnating maternal mortality rate when overall utilization and antenatal access by expectant Mothers is on the rise? Is it a clinical constraint or a financial constraint? How do we interpret the fact that about 90% of expectant Mothers go for antenatal, yet only 50% go to the hospitals for delivery?
How can we improve the filing of claims to ensure that we do not have cases where men are reported to have had caesarian sections? How can we stop the bills coming in for admissions when in fact these are detentions? All these delay the claims process.
How can we deal with co-payments, and the many who may be tarnishing the image of the Ghana Medical Association through fraudulent claims?
Given the significant improvements and investments and increasing access to health care that the scheme is championing, The GMA would agree with that the scheme really needs extra cash inflows to continue with its expansion program and to ensure sustainability.
I believe this forum is an opportunity for us all to seek redress that would truly open the dialogue for universal health care.