Hope in NHIS waned, Scheme starved of statutory funds

The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 to provide affordable healthcare services to citizens.

 The scheme was designed to ensure that every Ghanaian had access to quality health care, regardless of their financial status. However, after more than a decade of its implementation, it is evident that the NHIS is not working effectively.

The scheme is currently facing a myriad of challenges that threaten its sustainability. These challenges are like thorns that prick the smooth skin of a rose, causing discomfort and pain to the beneficiaries of the scheme.

Many beneficiaries cannot rely on the scheme to access quality healthcare, as their subscription, according to them, only ensures retrieval of their medical folders and payment of consultation fees. Even basic drugs such as analgesics, cough mixtures and antibiotics must be purchased by patients.

Some health facilities are also reluctant to treat NHIS card holders, rather prioritising services to persons with ‘ready cash’ to pay, reminding many of the gloomy days of the ‘cash and carry’ system.

Ineffective

The Minister of Health, Kwaku Agyeman-Manu, during the Ghana Health Service Senior Managers Meeting 2023 on Tuesday, April 18, 2023, stated that complaints from NHIS subscribers suggested that the scheme was not functioning correctly.

He expressed dissatisfaction with certain service providers under NHIS, whom he accused of extortion. He claimed that instead of benefiting from the scheme, poor subscribers were being overcharged and denied necessary services.

He cited his own experiences, claiming that he had to pay for healthcare services out of his pocket when he visited hospitals such as Ridge and the University of Ghana Medical Centre (UGMC), even though he was an NHIS subscriber.

Former President John Mahama has also waded into the conversation about the effectiveness of the scheme. At a ceremony in Tamale to accept his nomination by the National Democratic Congress (NDC) as its flag bearer for the 2024 election, Mr Mahama said the scheme had been starved of funds that was critical for its effectiveness. 

Where is the money?

While authorities may not admit, one of the major challenges facing the NHIS is inadequate funding.

A report by SEND Ghana on citizens’ assessment of social protection delivery in the country revealed that there were enormous liquidity challenges facing the NHIS. The report, based on previous budgetary allocation and spending between 2015 and 2019, suggested that not all the revenues generated from the NHIS Levy are credited to the National Health Insurance Fund (NHIF), although the NHIS largely depends on the Fund, which is 2.5 per cent levy on goods and services collected under the Value Added Tax (VAT), to finance its operations.

In recent times, the Minority in Parliament has led an onslaught, accusing the government of intentionally delaying funds for the Scheme’s operation in an attempt to collapse it. They insist, for instance, that the government paid only 6.2 per cent of the total funds needed for the Scheme at the end of 2021.

The situation has left the NHIS with a huge funding gap, leading to a situation where healthcare providers are not reimbursed on time, causing shortage of drugs and medical supplies.

Last year, the Auditor-General’s report suggested the National Health Insurance Authority (NHIA) owed 78 health institutions across the country to the tune of GH₵51.4million as of December 31, in violation of Regulation 38 of the National Health Insurance Regulations, 2004 (L.I.1809), which requires that a claim or payment of health service submitted to the scheme shall be paid within four weeks after receipt of the claim from the healthcare facility unless there is a legal impediment.

Abuse

Another challenge facing the NHIS is fraud and abuse. There have been reports of healthcare providers colluding with patients to defraud the scheme. Some providers inflate the cost of services rendered to patients, while others provide unnecessary medical procedures and treatments to increase their earnings. 

This has led to a situation where the NHIS pays for services that are not needed or provided at inflated prices.

The Upper East Regional Director of the NHIA, Kasimu Abdulai, in February this year, raised concerns over how fraud, perpetuated by some service providers, was contributing to the problems of the scheme.

“One issue we are going to pay particular attention to, in 2023, is the issue of illegal charges at the level of the facilities,” Mr Abdulai told the media in Bolgatanga.    

Although it has fallen short of expectations, a greater percentage of citizens believe that the NHIS was designed to be a game-changer in the country's healthcare system, and must not be allowed to fail. 

Their wish is for the government to address the challenges facing the NHIS by increasing funding, ensuring timely disbursement of funds, improving management and governance, and cracking down on fraud and abuse. Only then can the NHIS fulfil its mandate of providing affordable healthcare services to all Ghanaians.