NHIS MAKES GIANT STRIDES (Page 20)

Story: Kwame Asiedu Marfo, Sekondi

MANY people were sceptical about the viability of the National Health Insurance Scheme (NHIS) when it was introduced about four years ago.
Even some people, including politicians, decided to politicise its introduction, patronage as well as the successful implementation of the scheme.
However, a few years have passed and the scheme became operative in the districts. Now some of the clients have started to realise the immense benefits the scheme can offer.
In the Western Region, the scheme has made a remarkable impact on the health of the people in the districts where the schemes are being managed efficiently, particularly in the Bibiani Anhwiaso Bekwai District.
For the first time in the history of the district, malaria dropped as the leading cause of death in 2006 to the sixth place as of the end of June, this year.
Health experts have attributed this phenomenon to early reporting of malaria cases at health institutions, facilitated by the NHIS as well as strict adherence to malaria treatment protocols.
The Western Region has 15 District Wide Mutual Health Insurance Schemes. The schemes had registered 821,243 clients, representing 37.5 per cent of the regional population as of June 30, 2007.
Out of this figure, 486,744 identity cards, representing over 59 per cent, had been issued out to insured clients within the same period.
Over ¢12 billion has been collected in premium from clients in the informal sector. The Western Regional Focal Person on NHIS, Mr James Ohenmeng Kyei, made this disclosure in an interview with the Daily Graphic on the impact of the scheme on the health status of clients in the region.
He mentioned that according to statistics in the Bibiani Anhwiaso Bekwai District, utilisation level of health facilities by insured clients, representing 54.3 per cent, outnumbered non-insured clients.
Also, he said, 97 per cent of registered clients in the district had been issued with identity cards.
Mr Kyei, who is also the Western Regional Pharmacist of the Ghana Health Service, said there had been a steady increase in registration coverage due to increasing public confidence in the NHIS.
As of December 31, 2005, he said, the population coverage was 25 per cent and increased to 31 per cent by the end of 2006 and that as of June 30, 2007 the region had achieved a coverage of 37.5 per cent.
On whether the region would achieve the national target of 60 per cent coverage set by the National Health Insurance Council (NHIC) by the end of December 2007, Mr Kyei said the target may be too ambitious for the region as a whole due to a number of constraints.
However, he said, it was possible for at least five districts with over 40 per cent coverage as of 2007 mid-year to achieve the target.
“Indeed as of June 30, 2007, 162,563 clients representing 66.1 per cent of the district population of the Wassa West District had registered with the scheme”, he cited as an example.
Unfortunately, he said, six schemes had averages between 20 and 30 per cent, adding: “Therefore as a region, I believe that we can achieve a minimum of 45 per cent coverage by the end of the year”.
Reacting to clients’ complaints that they were wilfully delayed by the providers in the Ghana Health Service (GHS) facilities, he said it was a genuine concern expressed by clients.
However, Mr Kyei added that it had come to light that what had been perceived as wilful delay by the health providers was actually a delay caused by manual documentation.
He said further that the GHS had put in place an ‘internal provider-induced moral hazard’ in the submission of claims.
This control system, he said, involved a lot of documentation which, unfortunately, delayed insured clients.
Mr Kyei said the issue had been discussed at a national stakeholders meeting and that the National Health Insurance Council (NHIC) had promised to resource providers with computers and appropriate software to facilitate documentation.
This promise, if fulfilled, would eliminate manual documentation at least in bigger health facilities and the perceived wilful delay of insurance card bearers would be a thing of the past.
Concerning reports that insured patients were given cheap drugs such as paracetamol and multivite, he said the GHS facilities stock only quality and affordable medicines for both insured and non-insured clients.
According to Mr Kyei, malaria remained the leading cause of morbidity in the region.
He added that last year, malaria accounted for 45.5 per cent of all out-patients department (OPD) attendance.
“Therefore being prescribed and issued with two medicines on a visit to a health facility is normal and has nothing to do with one’s insurance registration status”, he added.
Mr Kyei also explained that the National Health Insurance Medicines List (NHIML) was a very useful document and that it met the World Health Organization (WHO) prescribing indicator target and must be encouraged.
However, he conceded that the revision of the NHIML was long overdue as a result of several challenges faced by the National Health Insurance Secretariat, adding: “I can assure you that the National Health Insurance Council will release the revised document soon”.
He said one of the challenges facing both providers and the schemes was the untimely release of funds by the NHIC for claims management.
Comparing the “cash-and-carry” system with NHIS, he said that before the introduction of the cash-and-carry programme availability of essential health commodities was less than 20 per cent.
However, he said, following the introduction of the cash-and-carry programme availability of health commodities shot up to about 98 per cent within 12 months and providers had access to essential quality medicines and non-drug medical consumables and that this led to client confidence in the healthcare delivery system at the time.
Therefore, he said, cash and carry achieved the aim of its introduction which was to ensure availability of quality essential medicines and non-drug medical consumables at all levels of health care at all times and at affordable prices.
Mr Kyei said health insurance on the other hand, had been introduced to remove financial barrier to health service and thereby provide registered clients access to quality health care without out-of-pocket payment being required at the point of service use.
Mr Kyei mentioned other challenges as lack of client understanding of NHIS, since some clients still presented receipts issued for premium payment to access health care as well as lack of logistics, such as printing and issuing of identity cards which affected the efficiency and effectiveness of the schemes.
Mr Kyei emphasised that the NHIS was a very important national development agenda and that all Ghanaians must come together to ensure its success.
He advised those who had not as yet registered with a scheme of their choice to do so, since it was in their own interest, adding that “since everybody pays indirect premium through the NHIS levy on certain goods and services all must register in order to reap the harvest”.