"Ghana\u2019s national health insurance users often end up paying as much as those who don\u2019t belong. So why join?"

" \r\n \r\n Ghana\u2019s national health insurance users often end up paying as much as those who don\u2019t belong. So why\u00a0join? \r\nHealth financing is a challenge any country has to deal with to provide good healthcare services. It\u2019s especially important for developing countries such as Ghana, where ability to pay is a hindrance to accessing all the healthcare services that people might need.\r\n\r\nThe \u201ccash and carry\u201d system, where sick people have to pay out of pocket to obtain care, has obvious adverse implications. People who can\u2019t pay won\u2019t be attended to. This could lead to irreversible consequences \u2013 even death.\r\n\r\nHealth insurance has come up as a means to provide subscribers with at least basic healthcare even if they are unable to pay.\r\n\r\nGhana\u2019s public health insurance programme, the\u00a0 National Health Insurance Scheme , was introduced in 2004. In principle it is mandatory, but in practice it is voluntary.\r\n\r\nThe active enrolment rate of the public health insurance scheme \u2013 the proportion of the population covered \u2013 rose to its highest in 2015, when it was 41%. At the end of\u00a0 2018 \u00a0it stood at 36%.\r\n\r\n(The National Health Insurance Scheme estimated the enrolment rate at end of year\u00a0 2021 at approximately 54%.)\r\n\r\nClearly, many people are not covered under the National Health Insurance Scheme. The low uptake is an impediment to achieving universal health coverage. But the question is why a social protection programme of this nature has relatively low coverage rates.\r\n\r\nThe scheme is designed to offer poor households exemptions from annual premium payments. Therefore, the ability to pay insurance premiums shouldn\u2019t be a contributing factor to the low coverage rates.\r\n\r\nPrivate health insurance programmes are not widespread in Ghana either. The\u00a0 Ghana Living Standards Survey 7 \u00a0conducted by the\u00a0 Ghana Statistical Services \u00a0in 2017 revealed that only 0.36% of the nearly 60,000 respondents had ever enrolled in a private health insurance programme.\r\n\r\nOne motivation for subscribing to the National Health Insurance Scheme would be if non-subscribers made higher out-of-pocket payments for healthcare than subscribers. If scheme members paid little or nothing and non-members paid more, then non-members might be motivated to enrol on the scheme.\r\n\r\nBut this is not often the case. The\u00a0 2017 survey \u00a0revealed that health insurance paid out only 16.7% of the medical expenses of the ill or injured across the country.\r\n\r\nContrary to expectation, our\u00a0 research \u00a0found that Ghana\u2019s national health insurance did not reduce out-of-pocket payments for those who had subscribed. Thus, the scheme may not be achieving its objective of eliminating the cash and carry system.\r\n\r\n Why enrolment doesn\u2019t pay \r\n\r\nThe National Health Insurance Scheme in Ghana has historically been bedevilled by several challenges in practice. Previous\u00a0 research \u00a0has reported that it is not uncommon for health facilities to charge both formal and informal fees even to insured clients.\r\n\r\nHealth facilities prefer to attend to patients who pay for treatment in cash rather than those who rely on their national health insurance policy to pay. That\u2019s because they must complete tedious paperwork and wait for a long time before the scheme reimburses them.\r\n\r\nThis forces patients wanting more timely and better quality of care to make these payments \u2013 overt or otherwise \u2013 sometimes completely forgoing the use of their national health insurance policies.\r\n\r\nThe medicines which the scheme covers run out quickly or are unavailable. So patients, insured or not, end up having to buy medicines themselves either from the health facility they visit or from private retail pharmacies.\r\n\r\n Some positive news \r\n\r\nThere were some positive findings from our research, however. We found that very poor households were more likely to enrol in health insurance than other households. This is perhaps because they are exempt from paying insurance premiums.\r\n\r\nThis suggests that the national scheme is achieving one of its objectives: increasing access to healthcare for the poor.\r\n\r\nAlthough the scheme does not lower health expenditures for members, it might enable them to receive a greater \u201cquantity\u201d of healthcare, since at least some of their health expenses are likely to be covered by insurance.\r\n\r\n What should be done? \r\n\r\nIf provider facilities did not discriminate against patients on the basis of who was willing to make a cash payment, and enrolled members did not have to buy the medicines they needed, people would be confident in using their insurance policies and might spend less out of pocket.\r\n\r\nThat might rake in more scheme members, which would increase the financial base of the scheme to keep it running effectively.\r\n\r\n \r\n "

"Ghana\u2019s national health insurance users often end up paying as much as those who don\u2019t belong. So why join?"

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