Health Insurance cannot be sustained with the 'generous package' - Former CEO

A former CEO at the National Health Insurance Authority (NHIA), Mr. Sylvester Mensah, has outlined some challenges confronting the scheme and how we can address them.

The man who managed the NHIA for a period of six years under the previous National Democratic Congress (NDC), said, the ''issues are technical and political''.

He noted that we turn to place more emphasis on the political solutions and leaving the technical solutions whereas the technical solutions are what will help sustain the scheme.

The former legislator for the Dadekotopon constituency in the Greater Accra Region from 1997 to 2001 explained, Ghana has helped other countries in their quest to establish health insurance schemes and in establishing such schemes, ‘’you first have to determine how much money you have into the future.

How much money are you ready to make available to the health insurance in the medium to long term? Give yourself a five year period; how much money year on year are you ready to provide? On the basis of that, you develop your basket of health benefits you want to pay for.’’

Mr. Mensah said, ‘’for the five years, you know that this amount will be increasing by 10 percent on annual basis; these are the conditions that the health insurance scheme intend to cater for. So there will be no major hiccups and cockups as you move into that period, after which there must be a review.

‘’But here we are, we begun with one of the most generous packages the world over, huge benefit package without recourse to the funding arrangement and so, the health insurance has kept panting from year to year, struggling to meet the huge basket of benefits and that has been the challenge. The cost of managing the scheme outweigh the inflows and so there is always a funding gap…This is the reality on the ground''.

The solution to the challenges he touted was the restructuring which started under his watch and recommendation was made to government to consider ‘’the need for restructuring and getting experts both locally and internationally to support in restructuring the scheme.’’

‘’It isn’t that we didn’t know exactly what to do but there was the need to develop some level of consensus and also bring individuals who had talent, who had experience, who are respected within the health insurance industry globally, in order to effectively provide some recommendations that could be respected, and serve as serious political dialogue in restructuring the scheme.’’ The benefit package in Ghana he asserted ‘’is too generous.

There is the need to rationale the benefit package. In pure terms, there is the need to reduce the benefit package because the benefit package is too huge.

It cannot be sustained. Government doesn’t have the money to cater for the package that we have…We have a very generous exemption regime.

All those who are 70 years and above are exempted from paying premium, all pregnant women are exempted from paying premium, all 18 years and below are exempted from paying premium, the poor are exempted from paying premium, the differently abled are exempted from paying premium and so you have a host of exemptions.

We need to inject equity into the scheme,’’ he suggested. He believes there are those who are capable of paying and those who are not capable of paying.

‘’…the blanket exemptions has outlived its usefulness. There is the need to inject equity and equity requires under the circumstances that, those who are capable of paying must be made to pay.’’

Using the analogy of a pregnant woman (expectant mother) who drives in a Mercedes X-Class to the hospital, he said, such a woman should not be exempted because she can afford to pay for her premium.

‘’If the idea was to meet the millennium development goals, we’ve gone beyond that now.

This is time to rationalize the scheme, we need to reduce the exemption regime, and we need to reduce the benefit package. We need to define what prime healthcare is.’’

The health insurance he emphasized must succeed and will give his support without seeking for financial benefits. ‘’I have a passion for it and it is one thing that I would want to succeed.

I wouldn’t want to be on radio criticizing the health insurance scheme… I would rather want to make contributions that would help improve the scheme.

I think that, we have a good management in place, I think they have their hands well on the ball, I think what the challenge is, is that political leadership is weak and politicians are playing politics with it.

And at the end of the day, management of the scheme, will be seen as the bad guys and may take the fall… That should not happen.

We must hold government responsible and accountable, and in doing so, we need to hold the president and the finance minister jointly responsible for the sustenance of the health insurance scheme,’’ he concluded.