“Everyone appreciates some degree of freeness. It is not just for any reason that I have subscribed to the NHIS, but because it reduces the amount of money I have to spend on seeking medical care,” Margaret, 45.
“Age is catching up with me so fast and for this reason I frequently visit the hospital. Being part of the NHIS has helped reduce the stress of having to put a lot of pressure on my children to pay for my medical bills,” Naana, 70.
“In 2009, my wife went through Cesarean Section at one of the government hospitals in Accra and was very successful. But guess what, I did not pay a single cedi for the surgery because my wife was signed on to the NHIS. This came as a big relief for me as a husband. It saved me some money to take care of my son and wife,” Paakow, 36.
Like Margaret, Naana and Paakow, many Ghanaians are benefiting from the National Health Insurance Scheme (NHIS) which was established some 17 years ago. But has it been an all rosy journey for the scheme to build its brand up to this point?
Biometric registration system
In August 2013, the Scheme introduced a biometric identity card which were issued instantly at the point of registration to subscribers to help organise properly, all basic biometric data of new and those renewing their membership. This is to also enable the scheme further secure collected data. The biometric card which is valid for five years and is subject to yearly membership renewals, contains basic biographic information and biometric data of the subscriber.
The security of the biometric card is guaranteed, in that, its features are more of electronic than physical due to the biometric nature of the data which is embedded in the memory of the card.
The experience of Maabena, 35, and mother of two confirms this. “At times, I can have my kids visiting the hospital at a time and I pray their data does not jam up. Due to their difference in age and the different kinds of medication they would be needing. But, interestingly, the machine picks each subscriber’s finger print and links it to their basic data. This process makes me feel secure when accessing health care under the National Health Insurance Scheme.”
Mobile membership renewal service
Recently, the NHIS has introduction of some technical innovations designed to make the NHIS more accessible to its members and also to improve upon the management of the scheme. One of such is the dedicated short code *929# set aside for the moble membership renewal.
With this service, members can renew their membership electronically in the comfort of their homes and at their own convenience through their mobile money wallet. They can check Policy Validity, Medicines list and Benefit Package.
26- year- old Eugene benefits from this service and he notes that “I am not signed onto the NHIS but most of the times I do mobile renewals for my grandma and it saves her the stress of having to join long queues and it also saves me the trouble of taking time off work to accompany grandma to do her NHIS renewals.”
The NHIS active membership has risen from 10 million as at the end of 2016 to 11.7 million. Subscribers conveniently have access to services in 4,600 Health Service Providers credentialed by the NHIA across the country. The Authority has so far cleared the 2016, 2017, 2018 arrears of claims and is on course paying 2019 claims.
According to Nii Ankrah, a user of the scheme, he feared being rejected access in some health facilities due to news reports on the failure of government to pay for the services rendered by health providers even though he has never doubted the credibility of the scheme. He further noted that the scheme has been very helpful to him anytime the needed to seek for medical assistance.
“There was a time I fell very ill at night and I had no more to attend the hospital. I would have been dead if not for the NHIS,” he said.
Despite the numerous benefits that subscribers are enjoying from the scheme, there has also been some challenges facing the national health insurance scheme. The scheme encourages service providers to provide full services to subscribers as long as it rest within the bothers of the NHIS.
The introduction of the NHIS in 2003 by government has significantly contributed to improve health services utilisation and health outcomes in Ghana. The scheme has become one major social intervention to provide access to quality health care for both residents and those who are on a visit to the country.
The scheme, which is largely funded by 2.5 percent of the NHIL levy on goods and services collected under the Value Added Tax (VAT) as required by law has seen major improvement by successive governments since it was introduced.
About the NHIS
Ghana’s National Health Insurance Scheme (NHIS) was created by the National Health Insurance Act of August 2003, and is one of very few attempts by a sub-Saharan African country to implement a national-level, universal health insurance program. A newly-created National Health Insurance Authority (NHIA) was commissioned “to secure the implementation of a national health insurance policy that ensures access to basic healthcare services to all residents.” The NHIA licenses and regulates district-level mutual health insurance schemes (DMHISs) as well as other schemes allowed under the Act, accredits providers, determines—in consultation with DMHISs—premium levels, and generally oversees and reports on NHIS operations. There are currently 145 district schemes.
The NHIS (including all DMHISs) has a single benefit package that is set by Legislative Instrument 1809 and described by the NHIA as covering “95 percent of disease conditions” that afflict Ghanaians.
The NHIS covers outpatient services, including diagnostic testing and operations such as hernia repair; most in-patient services, including specialist care, most surgeries, and hospital accommodation (general ward); oral health treatments; all maternity care services, including Caesarean deliveries; emergency care; and, finally, all drugs on the centrally-established NHIA Medicines List.
The NHIS package excludes some very expensive procedures such as certain surgeries, cancer treatments (other than breast and cervical cancer), organ transplants, and dialysis; non-vital services such as cosmetic surgery; and some high profile items such as HIV antiretroviral drugs (which are heavily subsidized by the separate National AIDS Program).
Other than the excluded services, there are few formal limits placed on NHIS members’ consumption of benefits—there is no cost-sharing beyond premiums (i.e., no co-payments, coinsurance, or deductibles), no annual or lifetime limits and little effective gate-keeping.
Benefits were intended to be “portable” from district to district, but actual portability has been mixed and is one reason for the recent introduction of a single, national NHIS identification card to replace district-level cards.