In what was widely acknowledged by participants as innovative and a global case study for social health insurance, the Chief Executive of the National Health Insurance Scheme, Mr. Sylvester A. Mensah, has described funding arrangements and bi-partisan political will for Ghana’s social health financing mechanism as two key strengths of the scheme.

The NHIS is principally funded from 2.5 per cent levy on goods and services and a transfer of 2.5 percentage points of social security contributions.

Speaking as a principal invited guest on the subject, ‘Adaptable lessons from the Ghana NHIS: a global cases study”. At the Global Health 2011 Conference in London, he highlighted the unique and exemplary features of Ghana’s scheme which made it worth emulating, and brought the world’s attention to the goodwill that the scheme enjoys from across the political divide.

The conference, which brought together health policy makers and business leaders across the globe, was jointly organized by the British Medical Journal (BMJ) and National Institute for Health and Clinical Excellence (NICE), and was under the theme ‘Policy for sustainable and effective healthcare’.

Touching on innovative ways of covering the poor and vulnerable, Mr. Mensah explained that under the National Health Insurance Scheme, persons under 18 years, over 70 years, social security contributors and pensioners, pregnant women, indigents and state-endorsed socially-identified vulnerable groups, were all exempt from paying premiums.

“The scheme allows for graduated premium for members from the informal sector, allowing for socio-economic separation of the rich and poor, particularly in the informal sector, for better targeting and optimum financial risk protection,” he said.

He said that to facilitate the achievement of the first Millennium Development Goal, the NHIS had as a key feature, free registration and access to healthcare for the poor and vulnerable, and this is meant to reduce and prevent catastrophic health expenditures and poverty for the poor and vulnerable”

Relating Ghana’s NHIS operations to the Millennium Development Goals, Mr. Mensah indicated that by exempting the poor and vulnerable from premium payment, the NHIS was preventing those groups from catastrophic health expenditures that could push them further below the poverty line, thus addressing MDG 1.

Furthermore, he said, children under 18 years old, representing 47 per cent of membership, were also exempt from premium payment, contributing to the reduction in child mortality under MDG 4, while the free maternal programme contributed to improving maternal health, MDG 5.

He also stressed that the scheme currently covered about 95 per cent of disease conditions in Ghana, including malaria and other HIV/AIDS opportunistic illnesses aimed at MDG 6.

“The NHIS Medicines List was derived from the Essential Medicines List of the Ministry of Health”, he added.

Mr. Mensah hinted that an NHIS Call Centre would soon be established to readily respond to queries and complaints from stakeholders, particularly subscribers, while a mechanism to link treatment directly to diagnosis, e-claims processing, the establishment of a Health Insurance Institute and the formation of a Stakeholders’ Advisory Committee (SAC) of the scheme were all in the works.

“These initiatives, are meant to address some of the challenges of the scheme, which include late submission of claims, challenges associated with renewal, and poor quality of services provided to members of the services provided to members by some schemes and service providers.” he said.

other challenges include means-testing to better identify the poor in the informal sector, constraints in ID card management, how to improve the selection of medicines to ensure value for money, reducing waste in the pharmaceutical supply chain , and pricing of health technologies such as equipment , medicines, vaccines and laboratory regents.

Mr. Mensah also introduced participants to the Health Insurance Value Chain, a framework for securing financial risk protection of the scheme, drawing from his experience as a finance and strategic management professional; adding that broad involvement of stakeholders in the development of NHIS systems was a critical success factor.

source: The Ghanaian Times

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