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Opinions of Saturday, 5 December 2009

Columnist: Adu-Gyamfi, Kwaku

A Good National Health Insurance Scheme Is ....

More Than An Access To NHIS Card. (part. 1)

We need a sustainable, measurable, accountable and responsive medical care.

WITH BAD ECONOMIC NEWS EVERYWHERE on the globe, and the agribusiness companies from the west and China aggressively exporting genetically modified and lead –contaminated food to Ghanaian consumers, health issues are going to be accelerated beyond the breaking point. So there is no better time than now to discuss the issue of our National Health Insurance Scheme (NHIS), its costs and how to improve the quality of health care delivery system in Ghana.

Sure, we need more doctors, hospitals and access to good medication and any other modern day equipment we can get in order to improve on the NHIS but, given the cost in providing an affordable, stable, measurable and sustainable medical care, no amount of doctors and hospitals or medication can compensate for a preventive medicine, especially where the patients are taught to take care of their personal preventable medical needs and preventable diseases.

No stable national health Insurance scheme can withstand the heavy load of the chronic preventable diseases that are linked to diet and questionable personal life styles. So we can not expect to get a better Health Insurance scheme without taking care of the poor, imported food consumption, personal responsibilities and imported fake medications.

According to a recent article in the New York Times,”three-quarters of the U.S health care spending goes to treat preventable chronic diseases that are linked to diet”. They are spending billions of dollars every year to treat obesity, diabetes, cardiovascular diseases and many types of cancer that studies have linked to poor diet. So before we tune-up our National Health Insurance Scheme we need to take a closer look at the GM (genetically modified) food we are wantonly consuming in Ghana. The World’s agribusiness companies with their GM food are going to promote and perpetuate food that will have very negative effects on our diet and health care system. Or do we have to fill our bellies first and worry about our health issues later? That’s what happens when we’re too lazy even to have vegetable gardens.

To get a better health care delivery in our part of the world, we need to cut the cost. And cutting the cost requires improving preventive medicine like---proper exercise, balanced nutritional diet, and a lifestyle that prevents illness. We have to find ways and means to limit the costs while improving the service by concentrating on preventive medicine instead of focusing on treatment and cure.

The issue of health care costs and delivery comes up for discussion when money is tight and people find it difficult to have an affordable nation-wide Healthcare plan.

Now, let’s take a look at our National Health Insurance Scheme’s. (NHIS) limitations, complexity, fragility and lack of its portability.

Kwadwo Antwi, a native of Atobriso, a village in the Kwaebiribrim District, is always skeptical when it comes to government’s programs. So when the National Health Insurance Scheme was introduced he was probably the last soul in Ghana to be on board.

Other than his decision being always controlled by paranoia and skepticisms, he had other reasons to justify his reluctance .He didn’t believe the news nor the initial fee of GH10.00, which was hard to come by. Nevertheless, after soul searching and head -scratching moments he reluctantly registered for it and subsequently got his Photo ID card after waiting for several months. He could use it anytime, anywhere he gets sick—free of charge, no questions asked. Right? Wrong! Hold on, not so fast. There is a catch!

Fortunately or unfortunately for him—he should thank his parents for the good genes he inherited. He doesn’t get sick very often so he never had the need to use the card until one fateful day when he visited his cousin at Akropong –Akuapim . After eating his banku with well-spiced Tilapia and hot pepper sauce he got sick. When he went to the local hospital he was told to go to his locality because the card was not issued at Akropong. Is not acceptable outside the coverage area of the card issuing district. I’m not making this up. In other words, for him to get any medical attention, he had to go back to Kwaebibrim district.

After hearing the story I tried to dissect it .So let’s see if I got it right. To make use of an insurance Plan one has to be in the same district. So using the Kwaebibrim district Health Insurance coverage card at any hospital outside the Kwaebibrim locality will not do you any good .Huh? It’s like one not being able to drive in Accra with vehicle insurance issued at koforidua. Huh? You got it? Good!

Maybe, to be on the safe side of things one has to get a card for every district of the nation just in case one gets sick outside his/ her locality. Don’t laugh. It doesn’t make much sense. But then we’re talking about Ghana.

After reading all the political debates about the national Health Insurance Scheme the only question that comes to mind is: whose idea was it? Who designed such a noble plan and turned around and screwed it up miserably? And, did he/she do any research as to how to manage the entire process? Ouch, I’m getting a headache; pass me the aspirin!

The point is the NHIS needs a lot of work to make it viable and stable for all who needs it. There are bugs (glitches) to be weeded out. First of all, is there a way for the registered applicants to be issued temporary cards so as to be able to get medical services, while they wait for the permanent ones to be issued? Why can’t the applicant who has registered get insurance coverage right away? I think the insurance plan should have a portable coverage that should travel nationwide. This is just a plea, if changes have been made yet.

For the National Insurance plan to be successful, viable and more in tune with our medical needs and concerns, we have to incorporate among other things; Health Awareness and Improvement as well as disease management programs. We also have to be vigilant of the importation of fake drugs and chemically saturated consumer products because they play a role in our health care equation.

According to health experts, the wellness and disease-management programs can slow the relentless rise of medical delivery costs. To reduce costs we have to introduce wellness programs like: diabetic management and smoking cessation. Obesity has to be addressed by encouraging a healthy diet and physical activities. We also have to put strong regulations on hazardous toxic substances that have negative impacts on health and environment. This is especially necessary for effluent from mining, domestic waste disposal, and other industries. We also have to make sure that children and the youth have decent places to engage in after –school physical activities.

To contain health care costs and improve care we also have to do the following:

1) Eradicate hospital and health center infections which are very prevalent. These can be done by cleaning the patients’ wards and wiping down the beds with anti-bacteria solutions.

Medical errors such as: wrong –site surgery and incompatible blood type transfusion should be prevented.

2)To reduction diabetes and pre-diabetic(Type 2) ,we have to concentrate on finding ways to fight obesity and pay more attention to weight management ,nutrition, fitness and health risk assessment.

3) We also have to reduce unnecessary health care being rendered to patients across the nation. For example, if kofi’s minor cut he sustained from the school’s playing ground was addressed, cleaned and dressed at his school right away, his wound would not get infected. Equally, people want their emotional problems to be treated at local health centers; all at the expense of health Insurance.

4) Since the local pharmacies (Drug stores) form a major part of the health delivery equation there should be a system to bring them on board. Most drugstore attendants do not clearly understand the instructions and the usage of the medicine they sell to the people. Also, some consumers cannot read the usage of the medication they buy. So in most cases either they take wrong dosage or misuse the medication. That can exacerbate the medical condition or prolong the cure of an aliment and that falls on the shoulders of the health Insurance. The importation of fake drugs into the country should be curtailed to control cost and render a better service.

5) In hard times like this, a health care system can not bear more uninsured and economically fragile people without increasing the cost of delivery. The Uninsured will crowd hospitals and health centers across the country when their medical problems become too severe to ignore as this is the only avenue they have to access basic health services. Such a trend will not only bring the costs up, but can easily bankrupt or break the health care system with severe consequences. So the government should come up with ways to attract and convince people, especially, the youth who think they will never get sick to get coverage.

Other ways to control costs and improve health delivery:

a) Companies and employers should also play a role by installing Fitness Centers with exercise machines to allow employees to exercise before and after work. The Districts Assemblies can also play a role by helping the towns within their districts to have Fitness centers. The government should train ‘”Health Coaches “to help and advice people with chronic conditions like; diabetic, asthma, high blood pressure and heart disease.

b)Every town should have monthly health meetings to guide people towards a goal like; losing weight ,eating healthy food, lowering blood pressure, and cholesterol level management.

C) To encourage people to be health conscious the government should offer the people reduced Insurance premium to participate in wellness programs. Married people should get additional discount if they bring their spouses to join. There should be health prevention services; including immunization and yearly physical exams.

d) There should also be incentive for people to own bicycles .To that end; the import duties on bicycles should be abolished. Better yet, we should have bicycle assembly plants in Ghana to make them more affordable and create jobs. I ’m even tempted to suggest that towns and villages can even have bike rental places as a mean to generate revenue and take care of citizens’ health. In France, Paris the city has 20,000 bikes available for the public to rent, all in the name of promoting good health.

e) The link between smoking and dangerous lung and heart problems is widely recognized. So those who smoke should be made to pay higher Insurance premiums unless they participate in programs that will help them quit smoking. There should be cigarette taxes to offset the damage it causes. The proceeds from the taxes should fund programs to help smokers quit smoking and buy fitness machines to stock the proposed “Townships’ Gyms”, build townships’ playgrounds and physical activity centers.

f) In Europe home owners are paid for installing a solar system on their rooftops. To encourage people from over using the medial system the government should reward citizens who can maintain a measurable healthy lifestyle. Those who purposely engage in destructive drugs or alcoholism should be forced to pay more for cigarettes and insurance premiums as a way to shift the burden of protection from the government to individuals.

g) Youth alcoholism is affecting the national health Insurance’s equilibrium, so we can’t pretend it will go away by itself. The youth need education, counseling, hope and worthwhile activities to engage in.

F)Mining companies like Newmont who pollute our rivers with cyanide and disrupt our environment should be fined and the money should fund programs that will help the affected communities and individuals to deal with the health issues they would encounter in the future.

The return on such investment is very difficult to measure, but I believe they will be a wise investment for the nation and its citzens.

Healthy employees are good for the bottom-line because they will treat their customers better and make them feel good. And, healthy citizenry is good asset for the nation like ours, which can ill- afford not to take care of its citizens.

With the current economic downturn, coupled with other uncertainties a country without a solid, well-grounded health care delivery system will exacerbate the economic “pains”. As a nation we need to find long –term solutions to our long-term medical problems.

Kwaku Adu-Gyamfi (The Voice of Reason) NJ, USA.

* The author is a social commentator and the founder of Adu-Gyamfi Youth, Educational and Apprenticeship Foundation of Asuom, E/R