The National Health Insurance Scheme would soon be a mirage if the scheme continues to operate as it is now as primary funding for it is fast dwindling. This is according to the Deputy Director of Corporate Affairs of the National Health Insurance Authority, Eric Ametor Kwame. ³After 2012, if things remain the same, we would not be able to pay service providers adequately, and that would mean we would not be in a position to provide services for our subscribers². ³We have done a study of our operations right from inception in 2004 and projections into the future. We have looked at our incoming financial resources, and our expenditure and we have seen that if nothing is done about our funding sources, in the near future, probably by 2013, the scheme would be facing financial problems², Mr Ametor Kwame told Emefa Apawu, host of the Big Bite on Xfm 95.1, a privately owned commercial radio station in Accra. According to him, the problem has arisen because the scheme since its inception has not had any major overhaul, compelling operators to rely on the old methods put out about six years ago in the face of increasing number of subscribers and beneficiaries. The problem, he said is compounded by the fact that about 70 per cent of the beneficiaries access the scheme free of charge without paying premiums, adding to its huge financial burden.

³The aged, children below 18 years, pregnant women etc all access the scheme without paying premiums. So with increasing numbers, is the need to look at funding sources to match². The National Health Insurance Scheme which had just about one million subscribers in 2004 can now boast of about sixteen million subscribers nationwide. However, there have been no increments in its funding sources. ³The NHIS levy is the largest source of finding for us. It provides us with about 65-70 per cent of the funding and so any measure to increase our funding sources should take into consideration increment of the levy², Mr Ametor Kwame said. He said following the impending challenges facing the scheme, his office has submitted the findings of a study it conducted to government to consider to ameliorate the impending challenges. ³In over five to six years now, we have not had any increment in our funding, and this is what we are asking the government to address now so that in the future, we would not have problems². And to check other challenges facing the scheme like fraud, Mr Ametor Kwame said ³we have taken very stringent measures to block leakages in the system.

It is one of our biggest challenges. Beginning this year, we instituted a clinical audit unit of the authority. We looked at payment even with forensic effects into some of the bad payments and we discovered a lot of fraud. As a result of the clinical audit, this year, we have been able to recover 16 million Cedis, and we have put in place measures to forestall such fraudulent payments². Mr Ametor Kwame is hopeful that such measures would help curtail the many challenges facing the National Health Insurance Scheme.

Story by Abena Asiedua Tenkorang Xfm 95.1, Accra, Ghana