19 October 2012

Ghana: Don't Use NHIS for Political Mischief - Sylvester Mensah

THE CHIEF Executive of the National Health Insurance Authority (NHIA), Mr. Slyvester Mensah, says that the National Health Insurance Scheme (NHIS) is too important and technical to be used for political mischief or discussed on a political platform.

He said discussing health insurance requires technical thinking, stressing that "The scheme is too significant to be experiencing such hit and run on a political platform. It is not desirable and deeply disturbing. "

He was responding to some issues raised by the New Patriotic Party (NPP) flag bearer, Nana Akuffo Addo, and other members of his party, concerning the NHIS at a forum in Sunyani, in the Brong Ahafo region, on Wednesday, October 17, 2012.

According to him, Nana Akuffo Addo in his statement spoke about active membership (AM) of the NHIS and "it was so clear he had no clue what the concept of active membership is. He spoke about utilization and he did not understand what it is. He spoke about capitation, which was too complex for his comprehension."

He added that the NPP flag bearer's plan for the future, which would be to ensure that children no longer tagged unto their parents as a way of accessing healthcare was rather pathetic because that is what already pertains.

He noted that the ideal situation would be for people who have concerns about the scheme to sit at a public forum to discuss the issues, saying "any social policy that affects over 50% of the population has the tendency of assuming a political life of its own."

He further noted that if over 50% of the population was benefitting from the financial risk protection under a particular regime, the general tendency and expectation of the political class is to assume that the people would then sway to the regime under which they were benefitting from the social protection.

He lamented that in the process, some other political interest groups were trying to puncture whatever achievement or benefits subscribers were getting and try to get them to appreciate that they were not getting enough.

He said this was understandable, but when it moved to the point where people try to misinform the public, then it becomes a great source of worry, stressing "What is even more disturbing and coming from otherwise very respectable people are the blatant lies, half-truths and poor analysis which smacks of mischief or complete ignorance."

Mr. Mensah observed that before January 2009, the NHIS, under Mr. Ras Boateng, the then acting chief executive of the NHIA had no Chief Director, and so Mr. Boateng was operating as the director of finance of the authority.

He also pointed out that the NHIA largely managed the NHIS fund and before January 2009, it had no fund and investment unit, and by implication, the CEO managed both his position and acted as head of the fund and investment unit.

Additionally, there was no human resource department in the authority and "worse of all, there was no internal audit, so the chief executive was the chief internal auditor, director of finance, the head of fund and investment unit, and head of HR, so he can he can say he heads a lean staff."

He said the NHIS currently had about the largest public service institution in the country, in terms of employees, but the situation that pertained prior to January 2009 was distant from efficient management, and the scheme could have collapsed under such circumstances.

According to him, "the NHIS we have today has become the toast of many countries across the globe," because of initiatives introduced between January 2009 to date, such as a review of the NHIA law. He said the law before the review was grossly dysfunctional and did not allow for administrational, operational and financial efficiency.

He questioned the decentralization of payments to service providers by the transfer of funds through the schemes to effect payment, "when we a have a matured banking system and where payments can be effected directly from the center into the account of any provider across the country."

This, he explained, was one of the arrangements the new law would address to avoid the cost involved in the transfer of funds.

Another issue he responded to was that of active membership of the NHIS. He said prior to 2009, the authority had a flawed method of calculating membership by the aggregate number of identity (ID) cards that have been issued, minus the number of expired cards.

He said from 2005 up to 2008, the active membership under the flawed approach was 9.2 million, saying "If we had applied the same approach to date, the active membership, as of December 2011, would have been around 18 million and that is inconsistent with the reality on the ground."

He said international best practice requires that "you pick the total number of renewals within the year, and add all new registrations within the year. If we applied this formula to the active membership of 9.2 in 2008, the actual membership would have dropped to around close to 4 million. We think that it is time we move away from processes and procedures that are inconsistent with international best practice and to do what is right and fair."

He pointed out that the investment portfolio of the scheme had become an issue for political discourse such that the NPP has stated that the investment portfolio stood at around 300 million as at the end of December 20008 but was now below 200 million.

In response, he noted that as far back as 2005, under the watch of Mr. Ras Boateng, there was an actuarial study which report revealed that if by close of 2009, additional funding was not secured by way of increasing the NHIS levy, the scheme was going to collapse.

"What we have done is to extend the sustainability of the scheme, beyond 2009 up to the close of 2012, before working on the injection of additional inflow", he stated.

According to him, if indeed, income exceeded expenditure in 2005 and continued up to a certain point in time, one would have expected the investment portfolio to grow, but sustainability required that "you also look at your income, growth and investment, before you inject additional inflows to redefine another sustainability period."

He added that sustainability was not defined in infinity, but within a specific time frame, thus "It is unfortunate that the people who should know better and are perceived to know better will want to use political platform in throwing dust into the eyes of the people for particular effect and purpose. This is unbecoming of otherwise respectable people in society."

He assured Ghanaians that "the health insurance as it is today is healthier than it was in 2008, because out-patient utilization in 2008 was around 9.3 million, and by December 2011, it had risen to 25.5 million."

Also, "in-patient utilization was around 600,000 in 2008, but as at December 2011, it was above 1.5 million. As at December 2008, total claims payment was around 183 million for a membership of 9.2 million, but as at December 2011, it had risen to 550 million, corresponding with the jump from 9.2 million to 25.5 million."

He concluded that the NHIA is too serious a social protection policy to be toyed with politically, stressing "It is important that we address the technical issues and ensure that as much as possible, we communicate to the public what the reality on the ground is."

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