Feature: An evaluation of the current National Health Insurance Scheme

Sorry, ma’am, your NHIS does not cover the prescription; you will have to pay before we give it to you. Have you ever encountered a situation where you had to pay for basic healthcare services after a consultation, even though your NHIS card was active?

Are you wondering if, indeed, the insurance card has relevance for accessing cost-effective healthcare? Do these and other questions regarding the potency of the National Insurance Health Card continue to linger in your mind?

There has been a lot of hullabaloo regarding the efficacy of the National Health Insurance Scheme since its implementation. Though it is a good course to eradicate the cash-and-carry system in healthcare and assist the less privileged to access healthcare without any financial burden, it seems the intention for the implementation is not being met as patients have to pay for basic medical bills such as medications and basic laboratory tests when they visit the hospital.

This is creating an atmosphere of uneasiness as the less privileged are burdened with the pain of accessing health care, which has made individuals feel hopeless about the health care provided in the country.

Background to the National Health Insurance Scheme (NHIS)

The National Health Insurance Scheme was established to annihilate the cash-and-carry system of healthcare access. The scheme is a publicly funded healthcare system established by the Government of Ghana in 2003. The program was a form of national health insurance established to provide equitable access and financial coverage for basic health care services to Ghanaians.

The replacement of the cash-and-carry system with the NHIS began with the enactment of the National Health Insurance Act (Act 650) in 2003 and the subsequent operation of the scheme in 2004.

The act also established the National Health Insurance Authority (NHIA), which regulates all health insurance schemes in the country and also implements the NHIS. Financing for the NHIS comes from a 2.5 percent tax charge on selected goods and services (which accounts for about 70 percent of revenue); from the 2.5 percent transfers from existing contributions in the Social Security and National Insurance Trust by the formal-sector workers (around 23 percent of revenues); and individual premiums and miscellaneous from other funds from investment returns from the National Health Insurance Council, parliament, or donors (the World Bank, International Labor Organization, and Danish International Development Agency).

The social intervention program was introduced by the government to provide financial access to quality healthcare for residents in Ghana. Its vision is to be a model of a sustainable, progressive, and equitable social health insurance scheme in Africa and beyond, while its mission is to provide financial risk protection against the cost of quality basic healthcare for all residents of Ghana.

Engagements

In an interview with Miss Eunice, a midwife at Nsem Government Hospital at Sefwi Wiawso in the Western Region, she said the NHIS has enabled easy access to healthcare as everyone can be attended to without having to pay before attention is given, and it has aided patients to seek prompt health aid when indisposed rather than staying at home because they do not have money.

As a midwife, she said, previously pregnant women used to deliver their babies at home due to financial constraints; this sometimes caused infections in the mother and childhood diseases in the babies due to the inexperience of the people who assisted in delivery, but with the introduction of the NHIS, pregnant women now come for antenatal care and delivery, which she believes has reduced the mortality rate of mothers and their babies.

Though helpful, most drugs are not covered by NHIS, which she says is a great concern to her and other health workers in the hospital because most patients now come to the hospital because they believe they can get medicine after consultation, but unfortunately, they get disappointed because the pharmacist writes the prescriptions for them to buy since NHIS has not released the money needed to compensate for the giveaway of the medicine. Because of this issue, people do not come to the hospital until their illness becomes serious, which renders them helpless in giving the best health care to patients.

Miss Gifty, a nurse at Asamankese Hospital in the Greater Accra Region, added that before the introduction of the NHIS, there were some services patients could not afford, which resulted in the deaths of these patients and the severity of their cases.

As a nurse in a rural community She said previously, due to a lack of money, people in the community resorted to concoctions that were not measured to ascertain the right dose they needed to take, but with the NHIS, they now visit the health facility for medical aid. Personally, she identifies that there are shortcomings with the policy; she said a lot of medications and services that are basic in the policy have been alienated, which renders low-income earners handicapped. “This is dominant in people having kidney issues who need a transplant.

“I went to the hospital with my NHIS card and was told by the pharmacist that the prescriptions are not covered by my NHIS, hence I needed to pay before they could be delivered to me. My parents have also faced the same issue, and I cannot recall a time when the NHIS covered my medications. Though not functional to expectations, it has and is aiding the poor to access health care with the little they have,” said Mr. Richard, a student at the University of Ghana.

On her part, Anna, a tertiary student, believes the policy so far has not served its purpose.

Buttressing her statement, she said the NHIS is covering the minute cases in health even though it is not efficient because, upon the card being active, money is still demanded for the basics like laboratory tests.

She said the policy needs to be reviewed to cover major health cases like surgery and to assist those who cannot pay; this, she believes, will reduce mortality in people who need to undergo the surgery.

Conclusion

The National Health Service Scheme, upon its implementation, has positively discharged its mandate by helping Ghanaians, especially the poor in rural areas, access healthcare with smiles.

Other areas need to be looked at critically so quality healthcare for people will not be jeopardized. The initial mandate of the policy is not fully fulfilling the course it laid down to fulfill; this assertion stems from the concerns raised by the public and health practitioners.

This questions the interventions the NHIS is putting in place to help the poor and needy access quality health care. Given these reactions from the public, the government and the various stakeholders in charge of the policy need to review the policy and connect the missing dots that are inhibiting the success of the scheme.