Let’s begin dialogue on NHIS

All over the world social health insurance offers the best option for making health care cheap and accessible to all.

As the name implies, it is a social package involving all the people who put together a portion of their taxes or insurance premium to finance health care, as opposed to cash and carry which was fully operated in Ghana until 2005 when it was scrapped.

The National Health Insurance Scheme (NHIS) offered the opportunity for all contributors to access health care without necessarily paying for consultancy fees or prescribed medication.

However, even countries noted for the operation of health insurance, such as Germany, the UK, the USA and Canada, have been confronted by challenges.

National health insurance, sometimes called statutory health insurance, is a legally enforced scheme of health insurance that insures the population against the cost of health care.

It may be administered by the public sector, as is the case in Ghana with the National Health Insurance Authority (NHIA), or the private sector, which is mutual health insurance, or a combination of both.

Funding mechanisms vary with a particular programme or country. In Ghana, the scheme is funded from the National Health Insurance Levy, portions from social security contributions and direct payment by mostly people from the informal sector.

Having been in operation for more than a decade now, the NHIS is still grappling with teething problems. The scheme owes service providers millions of cedis, while the service providers also delay in submitting claims or inflate the claims.

The scheme is also bedevilled with extreme partisan politics, depending on which side of the political divide one belongs to.

From whichever angle the scheme is looked at, those who have assessed health care with NHIS cards speak well of the initiative.

The Daily Graphic thinks after the existence of the scheme for a while now it is about time the government initiated a national conversation or dialogue with the view to ironing out the challenges facing the policy.

It must be clear to us now that the scheme is challenged. Every day, service providers, premium holders and, indeed, the NHIA have issues with the implementation of the social health insurance policy.

Officials of the NHIA always complain about delays in the submission of claims, as well as inflated claims and inadequate budgetary support for the policy.

Premium holders also complain about lack of attention by some service providers and the exclusion of some essential medication on the drug list, while service providers also have their issue — delays in the payment of claims.

There is no doubt that the scheme is good, but we ought to avoid a situation where the non-payment of claims has left the St Dominic Hospital at Akwatia in the Eastern Region in a serious financial mess.

The NHIA is reported to be indebted to the hospital to the tune of GH¢3,913,101.88, being arrears for 2015 and 2016.

The authorities there are said to be reverting to the cash-and-carry system and also laying off some staff paid from its internally generated funds.

Perhaps what the government should be looking at now is an increase in the health insurance levy and the premium, so that the scheme can become financially sound to cater for the health needs of all contributors.

We do not want to be called prophets of doom, but the reality is that if steps are not taken to immediately redeem the scheme, it risks collapse. This will be a tragedy and must not be allowed to happen.