The Chief Executive of Ghana's 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 funded from 2.5% levy on goods and services, and a transfer of 2.5% contribution of workers contributions to the Social Security and National Insurance Trust (SSNIT).
Speaking on the subject "Adaptable Lessons from Ghana's NHIS: a Global Case Study", at the Global Health 2011 Conference in London, United Kingdom, he highlighted the unique and exemplary features of the scheme in Ghana.
The conference, which brought together health policy makers and business leaders across the globe, was jointly organised by the British Medical Journal (BMJ) and National Institute for Health & Clinical Excellence (NICE), under the theme "Policy for Sustainable and Effective Healthcare."
Touching on innovative ways of covering the poor and vulnerable, Mr. Mensah noted that under the National Health Insurance Scheme in Ghana, persons under 18 years, over 70 years, social security contributors and pensioners, pregnant women, indigents and state-endorsed socially-identified vulnerable groups such as Livelihood Empowerment Against Poverty (LEAP) beneficiaries, are all exempt from paying premiums.
Mensah noted that to facilitate the achievement of the first Millennium Development Goal (MDG), the NHIS has, as a key feature, free registration and access to healthcare for the poor and vulnerable.
He indicated that by exempting the poor and vulnerable from the premium payment, the NHIS was preventing those groups from catastrophic health expenditure that could push them further below the poverty line, thus addressing MDG 1.
He indicated that children under 18 years old, who represent 47% of membership, were also exempted from premium payment, contributing to the reduction in child mortality under MDG 4, while the free maternal program contributed to improving maternal health under MDG 5.
The CEO also stressed that the scheme currently covers about 95% 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.
The NHIS boss said the leadership and management were currently looking beyond "now" to address emerging sustainability challenges confronting the scheme. As part of measures, a Clinical Audit process was put in place in 2010 to review claims payment, assure quality of care, and check supply side moral hazards that had bedeviled the scheme.
Mr. Sylvester 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, he said, are meant to address some of the challenges of the scheme, which include late submission of claims, and challenges associated with renewal, and poor quality of services provided to members by some schemes and service providers.
Mr. Mensah 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 the broad involvement of stakeholders in the development of NHIS systems was a critical success factor.
Other speakers at the conference included Mr. David Brennan, CEO, AstraZeneca, the Ministers of Health from Turkey and Vietnam, and Sir Andrew Dillon, Chief Executive of NICE, UK, among others.
The conference is a two-way learning experience between health policy makers and business leaders.