The time has come for dialysis treatment to be placed on Ghana Health Insurance Scheme; lessons from the USA

Dialysis has been rampant in Ghanaian news recently. As a prospective Certified Hemodialysis Technician (CHT) in the US and an interested Ghanaian observer, please permit me to add my voice to the discussions.

In late September 2023 Ghanaians were thrown into lamentation as Korle Bu Hospital increased the cost of dialysis from GHS380 to GHSD765.42 – a more than 100% increase. Most patients on Dialysis attend a minimum of two treatments a week. This means at the old rate they were paying a minimum of 380 x 2 x 4 = 3,040 a month which has increased to a minimum of 765.42 x 2 x 4 = 6,123.36 a month.

I can state categorically without any fear of any contradiction that in Ghana 99% of the population cannot afford these fees. It therefore brings to the fore the need to discuss what the government can do to help Ghanaians who are on dialysis and stand in grave danger of resigning their fate to simply stop dialysis and die. The harsh reality is that once a patient in Ghana is diagnosed with ESRF, he or she is literally “on his own.”

If he/she is lucky to be accepted to either Korle Bu or Police hospital then the payment per dialysis session will be heavily subsidized. The private dialysis clinics do not entertain any discounts and sadly they are in the majority. Out of a total of 13 dialysis clinics serving the entire country only a couple belong to the government.

The Ghana kidney fund and foundations are civil society organizations that provide direct financial assistance to ESRF patients but they are severely limited by their sources of funding which are mainly donations. Lastly funding comes from personal savings, family contributions and inheritances and appeal for funds from old classmates and college and university alumni.

In my humble estimation, most of these financing options are woefully inadequate and funds are quickly drawn down. Remember that until a transplant is done, stopping dialysis is not an option because that means certain death. Unfortunately families are sometimes forced to make that decision once all available funding sources dry up and there is none whatsoever in the horizon. Now it remains to consider the case of the USA and what methodologies are in place to help patients on Dialysis. Here are the bare facts.

1) First and most important in 1972, President Nixon and congress signed a bill ensuring free dialysis and renal transplants for US citizens. The consequences of this bill are as follows:

a) On average Medicare covers 80% of dialysis costs.

b) Medicare covers 80% of of the costs for kidney transplants and

c) Medicare B covers 80% of immuno suppresant medication costs.

d) On average each dialysis patient costs Medicare about $90,000/year. This totals $28 billion/year and composes roughly 7% of Medicare spending. And 1% of the entire federal budget.

2) A second way to pay for dialysis is through Private Insurance. In this scenario a dialysis patient who has a private health insurance will pay a monthly premium plus deductibles, co-insurance and co-payments. Then the private insurance company will in return pay for the dialysis treatments.

3) A third system of payment is through Medicaid which is government health insurance for people who have low income or disabilities.

4)The fourth and final method is through civil society organizations such as The American Kidney Foundation(AKF). AKF provides assistance as funding becomes available from individuals, foundations and corporations who support their independent nonprofit work with charitable donations.

The assistance is need-based and includes helping patients with health insurance premiums, transportation costs, prescription medications and many other necessities related to kidney healthcare and our medically reviewed education resources to help people prevent and manage their kidney disease.

Having juxtaposed the Ghanaian reality with that of the US, one thing becomes abundantly clear. The US model is better. In fact it is the Gold Standard.

Consequently, the answer to the defining question of whether dialysis treatment should be covered by the national health insurance scheme, should be a resounding YES!!!.

1) In fact the parliament of Ghana should sponsor a bi-partisan bill as a matter of urgency and have this bill passed into law before the elections of 2024.

2) Parliament should follow this law with an amendment to remove all taxes on dialysis consumables. If not a 100% removal at least 75%.

3) third, governments and businesses should join hands to increase the endowment fund of the Ghana kidney foundation with a one time donation of at least 10 million dollars. At a conservative interest rate of even 10% that will generate a minimum of 1,000,000 dollars a year which will go a long way to pay for some if not all the fees of most Ghanaians on dialysis.

3) Fourth as the old adage says, Prevention is better than cure. Therefore a lot of effort must be put into preventive education to prevent people from getting into kidney problems to begin with. This means diet and nutrition education to be combined effectively with lifestyle changes such as exercise and non sedentary lifestyle.

5) Finally the call for a comprehensive law on harvesting and should be trumpeted on all the roof tops. In the US 20,000 kidney transplants are done every year. That changes lives for these people and gives them a new lease on life. Ghana just completed its very first transplant so we have a long way to go but the journey of a thousand miles starts with one step. The ministry of Health should therefore be relentless in collaborating with parliament to pass the law and see to its implementation.

For my concluding remarks, let me just say that a nation that does not take care of its very weak, sick and vulnerable is a failed nation and I will hate to think that my beloved country, Ghana is a failed state. I therefore appeal to those in the corridors of power, and thos who hold the purse strings, especially the finance minister, to do this one thing for suffering Ghanaians.

In Mathew 25:35-36,40 God wants our lives to overflow with mercy, love and compassion. As followers of Jesus we are reminded to serve the least in society which certainly includes the poor, downtrodden, weak, vulnerable and sick of our societies. The words “………Whatever you did for one of the very least, you did for me” are indeed eternally powerful.