National Health Insurance Scheme

Ghana is a country in sub-Saharan Africa. It is the first country south of the Sahara to have gained independence. From 6 March 1957 when the British granted the country's independence, the country went through several stages in its political journey. The country has suffered much from coups and bad governance. One area that suffered all through the turbulence was the country's health system.The Ministry of Health^[1] through its numerous agencies are in charge of the country's health care system.^[2] Until the establishment of the National Health Insurance Scheme, many people died because they did not have money to pay for their health care needs when they were taken ill. The system of health which operated was known as the "Cash and Carry" system. Under this system, the health need of an individual was only attended to after initial payment for the service was made.^[3] Even in cases when patients had been brought into the hospital on emergencies it was required that money was paid at every point of service delivery. When the country returned to democratic rule in 1992, its health care sector started seeing improvements in terms of:

• Service delivery
• Human resource improvement
• Public education about health condition

even with these initiatives in place many still could not access health care services because of the cash and carry system.

Birth of Ghana's National Health Insurance Scheme

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived by former president John Kufour who when seeking the mandate of the people in the 2000 elections, promised to abolish the “cash and carry system” of health delivery.^[4] Upon becoming president, former president Kufour pushed through his idea of getting rid of “cash and carry” and replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment. In 2003, the scheme was passed into law. Under the law, there was the establishment of National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes in Ghana. Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of its citizens.

NHIS policy

The health insurance was set up to allow everybody to make contributions into a fund so that in the event of illness contributors could be supported by the fund to receive affordable health care in our^[who?] health facilities. Under this policy, three types of health insurance schemes were set up. They were:

• The District-Wide Mutual Health Insurance Scheme.
• The Private Mutual Health Insurance Scheme.
• The Private Commercial Health Insurance Scheme.^[5]

In order for the system to function well, the government decided to support the District Mutual Health Insurance Scheme concept to ensure that:

• Opportunity is provided for all Ghanaians to have equal access to the functional structures of health insurance.
• Ghanaians do not move from an unaffordable ‘Cash and carry’ regime to another unaffordable Health Insurance one.
• A sustainable Health Insurance option is made available to all Ghanaians.
• The quality of health care provision is not compromised under Health Insurance.

Premiums

Like all insurance schemes, different types of premiums are available under the country's NHIS. Contributors are grouped according to their levels of income. Based on the group a contributor may fall in, there is specific premium that ought to be paid. This was done since the socio-economic condition scheme contributors is not the same and the contributions was to be affordable for all to ensure that nobody is forced to remain in ‘cash and carry’ system. This meant that contributions payable could vary from one district to the other as even the disease burden was also not the same in all the districts. To ensure that all citizens made some contribution to the scheme, a 2.5% Health Insurance Levy on selected goods and services was passed into law so that the money collected could be put into a National Health Insurance Fund to subsidize fully paid contributions to the District Health Insurance Schemes.

Nature of the scheme

In order to ensure the continuity of the scheme, two major lists were made. One had the all the conditions that the scheme could cover with the other have the excluded conditions.

Diseases covered under the scheme

The Government came out with a minimum benefit package of diseases which every district-wide scheme was to cover. This package covered about 95% of diseases in Ghana. Diseases covered included among others:

• Malaria
• Diarrhoea
• Upper respiratory tract infection
• Skin Diseases
• Hypertension
• Diabetes
• Asthma

However, all district-wide schemes were given the right under the law to organise their schemes to cover as many diseases and services as they desire, provided it was approved by the National Health Insurance Council.

Exclusive list

Certain diseases were however excluded from the benefit package because it was considered to be too expensive to treat. Therefore other arrangements had to be considered to enable people get these diseases treated. Diseases currently not covered are:

• Optical aids
• Hearing aids
• Orthopaedic aids
• Dentures
• Beautification Surgery
• Supply of AIDS drugs
• treatment of Chronic Renal Failure
• Heart and Brain surgery, etc.

All these constitute only 5% of the total number of diseases that Ghanaians suffered from.^[6]

Scheme coverage

The government supports all 138 Districts, Municipal and Sub-metro schemes in the country with funds from Highly Indebted Poor Countries (HIPC) to the various districts to facilitate the set-up of the schemes.

Controversies

Since the inception of the scheme in 2003, there have been a lot of controversies surrounding it operation and purpose. The first one was to do with members of the opposition National Democratic Congress (NDC), whose members claimed that the scheme was one made for members of the then ruling New Patriotic Party (NPP). As such many members of NDC did not want to register with the scheme. On the other hand it was reported that members of the NPP did not encourage members of NDC to join since it was a policy that had come during the time when the NPP was in power. The reverse of all the propaganda that surrounded the scheme at its inception were revisited in 2009 when the NDC took over power.^[7] Currently, the controversy with the scheme has to do with the proposed one-time premium payment. This idea was included in the ruling party's manifesto. The promise has so far not come into fruition as the date for its implementation is constantly postponed.^[8] Many critics of the proposal claim that it is just not possible to support the scheme with a one-time premium since the sustainability of the scheme would not be possible if premiums were not paid yearly.^[9]

References

1. ^ http://www.moh-ghana.org/
2. ^ http://en.wikipedia.org/wiki/Health_care_in_Ghana
3. ^ http://img.modernghana.com/images/content/report_content/NHIS.pdf
4. ^ http://www.ghanaweb.com/GhanaHomePage/health/national_health_insurance_scheme.php
5. ^ http://img.modernghana.com/images/content/report_content/NHIS.pdf
6. ^ http://img.modernghana.com/images/content/report_content/NHIS.pdf
7. ^ http://www.modernghana.com/news/219867/1/nhis-seized-by-ndc.html
8. ^ http://news.myjoyonline.com/health/201007/49927.asp
9. ^ http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=199496