Funding gap between NHIL and NHIS projected to widen

Health Minister Dr Kwaku Agyemang-Mensah has projected a widening financing gap between the National Health Insurance Levy (NHIL) and the National Health Insurance Scheme (NHIS).

He said the NHIL allocation for the NHIS, over the last three years, continues to fall short of the expenditure requirement of the scheme.

“The funding gap trends shows a gap of GH¢ 144.74 million in 2012, GH¢ 118 million in 2013 and GH¢ 299.18 million in 2014,” the Minister said on Thursday on the floor of Parliament as he briefed members on the status of the scheme.

His statement was in fulfillment to a plea to be given some time to reconcile all figures and information on the NHIS and come back to give the appropriate figures when he appeared before the House to answer questions related to the health sector a fortnight ago.

According to the Minister, the scheme was expected to be confronted with a funding gap in excess of GH¢ 299 million in 2014.

“If the financing regime is not reviewed for additional inflows, the funding gap is projected to increase from GH¢ 347 million in 2015 to reach a projected gap of GH¢ 803 million in 2018.

“These estimates are based on very moderate increases in NHIS membership of not more than one percentage point per annum with respect to the national population,” Dr Agyemang-Mensah said.

On claims paid to date, the Minister gave a figure of GH¢ 761.25 million, which, he said, represented 81 per cent of total receipts for 2014. Claims for the months of June to October 2014 are estimated at GH¢ 425 million remains outstanding.

The Minister said with the increasing growth in membership and utilisation, the total cost of providing health care for NHIS subscribers was growing faster than the annual financial resource allocation to the scheme with its consequent severe financial pressure.

Currently claims payment is in arrears of an average of five months across the country.

Dr Agyemang-Mensah announced strategies by the National Health Insurance Authority to reduce abuse of the system and address the critical financial situation confronting the scheme to ensure efficiency and sustainability.

These include regular clinical audits in NHIS credentialed facilities to review claims payment, establishment of claims processing centres, introduction of a consolidated premium account and the establishment of electronic claims and processing regime for greater efficiency, speed and uniformity in claims management.

Introduced by the National Health Insurance Law, Act 650 of 2003 and replaced by Act 852 of 2012, the NHIS has the primary objective of providing financial risk protection for residents in the country without having to pay cash at the point of service delivery.