Health News of Thursday, 1 November 2012
The National Health Insurance Authority (NHIA) is concerned about what seems to be a misinterpretation of data and other related issues appearing in its reports, and which issues have attracted media attention for some time now.
One such concern is the suggestion that active membership of the scheme is declining, based on figures from the 2010 NHIA Annual Report.
The facts of the matter are that up until 2009 the predominant mode of reporting NHIS membership was cumulative membership. This was done by cumulatively adding members registered in previous years to members registered in the current year.
Had this method continued, the NHIS would have more members than the entire population of the country by next year. In 2010, management decided to revise and improve the method of reporting to ensure that the internationally-accepted definition of a member of a health insurance scheme, was adopted. The membership figure derived by this method, called active membership is what the NHIA currently reports.
Attempts to calculate active membership in the past were flawed by the manual nature of reporting, where there was a perverse incentive for some schemes to overestimate registrations, as subsidies paid to them were based on number of persons in good standing.
With the experiences of the previous years, and the advent of a centralized ICT system however, this incentive progressively disappeared, leading to the development of an internationally-accepted system based methodology for calculating active membership from 2010 onwards.
Indeed on page 16 of the 2010 NHIA Annual Report, a table, which makes a clear distinction between active membership figures from the old methodology and new methodology, is presented. In that table, there is no past comparator for the 2010 active membership figure, being the first year of application of the new methodology. That same page of the annual report has a write up to explain the table, noting at the bottom of the table that the new active membership figure for 2010 does not necessarily represent a drop as there is no comparative historic data based on the new methodology.
It is therefore inappropriate to compare the 2010 active membership figure to any other figure in the past as these are based on different methodologies. As a matter of fact, had the Authority continued to use the cumulative methodology for calculating membership, the NHIS would by now have become the ridicule of the world as it will have more members than the population of the country by next year.
The Authority will like to state that the initiative to clean-up NHIS data and move towards an international standard for reporting is one of many bold attempts by the Authority to paint a realistic and open picture of the scheme for effective policy and strategy development, and to take the scheme to the next level of excellence. The NHIA will therefore be grateful if such technical issues are discussed and interpreted dispassionately, and is open to explaining any gray areas on the operations of the scheme to any member of the public who wishes to have further insight into Ghana’s NHIS.
National Health Insurance Authority