Tuesday, 17 September 2013

10th Anniversary Of The NHIS

A decade ago, following series of pilots in selected districts, the National Health Insurance Act, 2003 (Act 650) was passed by Parliament into law. The scheme has since grown to become a major instrument of financing healthcare delivery in Ghana. Currently, it engages more than 3,200 providers of healthcare services to nearly 9 million active NHIS subscribers. These subscribers have access to a benefit package covering about 95 percent of disease conditions in the country. The scheme currently provides premium-free healthcare for seventy percent of its total registered membership underscoring its social protection credentials. It is clear that the scheme is today credited with improvements in the healthcare of many people. In the relatively short period of its implementation, NHIS has gained international recognition culminating in the UN Award for excellence and leadership in November 2010. Again, a World Bank Report released in August last year, among other observations, noted that consumer satisfaction with the NHIS was high. Over the decade the scheme has grown exponentially from a small membership base of a little over one million in 2005, to nearly 9 million active members in 2012. The increase in membership and utilisation of healthcare services underscores the schemes popularity and significance. Nevertheless, this has also resulted in a corresponding increase in claims payment from seven point six million Ghana cedis in 2005 to 550 million Ghana cedis in 2011. Again, management has put in place structures to increase efficiency, contain cost, improve quality of care and secure the long term viability of the scheme as well as meet the MDG's 4 and 5. In 2008 for instance, the NHIA introduced the free maternal care programme which has been re-packaged and enhanced for pregnant women. The package has been streamlined to prevent its abuse. The programme is important in the drive to reduce and ultimately eliminate maternal mortality.

The scheme in 2009 developed a formal accreditation system to maintain quality standards. Another landmark initiative by the NHIA is the introduction of clinical Audit. Since January 2010 when the clinical Audit was introduced 20 million Ghana cedis has been recovered in respect of false claims. A vast improvement in claims management was achieved with the establishment of a state of the art claims processing center. The centre has rejuvenated and resourced the internal audit to be transparent and enhance accountability and expose malfeasance. Such audits are instilling financial discipline in the scheme. The NHIA in 2012 organised a provider payment reform to contain escalating cost, rationalize health care provision, eliminate delays in reimbursement of health care providers, improve quality of care and check the tendency of subscribers to visit numerous providers oblivious of the cost implications. Capitation, an additional payment mechanism has therefore been introduced to improve subscribers’ quality of care through improved doctor-patient relationship, ready access to medical records and history of patients, and competition between providers for clients. All these initiatives including; the introduction of the instant biometric ID cards to eliminate difficulties in ID card management, authentication of subscribers at healthcare facilities, and to check fraud and abuse. The NHIS ICT system has been upgraded with the creation of ultra-modern data centre and the necessary processes completed for the electronic linking of diagnosis to treatment to facilitate electronic claims processing.

It is indeed refreshing that the profile of the NHIS in the global arena continues to rise. It has become a favourite destination for delegations from foreign countries and institutions seeking to learn from Ghana's experience. The 10th anniversary commemoration which is under the theme: Towards Universal Health Coverage: Increasing Enrolment whilst Ensuring Sustainability, coincides with the implementation of the new NHIS, Act 2012 Act 852 which enjoyed bi-partisan support in its passage. The new law creates unitary scheme and ensures greater efficiency in the operations of the scheme. Such modest milestones chalked up against challenges and the positive difference the scheme is making to the lives of the people, provide a reason to celebrate the NHIS and galvanize the abundant goodwill, support and expertise for the next phase of implementation. On this occasion, it is appropriate to acknowledge the contributions of all Ghanaians particularly, subscribers and development partners as well as the hard-working staff of the NHIA for a good work done.

BY: GEORGE K. ANKRAH, A JOURNALIST.

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