PHM-Exch> New report finds serious flaws with Ghana?s Health Insurance and warns other countries not to copy

[Claudio Schuftan]

From: Anna Marriott <AMarriott at oxfam.org.uk>

 A new report launched today in Accra by Ghanaian NGOs in partnership with
Oxfam International brings new research to confirm serious flaws with the
scheme. For the international health community and other developing
countries the message is quite clear - we have been misled about Ghana's
progress to date. Health insurance has still not been proven to work at
scale in low income countries with widespread poverty and a large informal
economy. Instead the inequity, inefficiencies, cost escalation and sheer
complexity of the insurance scheme in Ghana should serve as a caution to
other developing countries thinking about doing the same.

So on to the main findings in the report:

   - Coverage of Ghana's National Health Insurance Scheme (NHIS) has been
   hugely exaggerated and could be as low as 18% - less than a third of the
   coverage suggested by Ghana’s National Health Insurance Authority and the
   World Bank
   - Every Ghanaian citizen pays for the NHIS through VAT, but as many as
   82% remain excluded
   - Twice as many rich people are signed up to the NHIS as poor people
   - Those excluded from the NHIS still pay user fees in the cash and carry
   system. Twenty five years after fees for health were introduced by the World
   Bank, they are still excluding millions of citizens from the health care
   they need
   - An estimated 36% of health spending is wasted due to inefficiencies and
   poor investment. Moving away from a health insurance administration alone
   could save US$83 million each year. Enough to pay for 23,000 more nurses


The report calls for the Government of Ghana to move quickly to implement
its own promise to remove the requirement for regular premium payments and
make health care free for all in public facilities by 2015. This should
include abolishing fees in the parallel cash and carry system.

The insurance bureaucracy should be overhauled and the National Health
Insurance Fund transformed into a National Health Fund to pool fragmented
financing and co-ordinate spending across the sector.

At the same time a rapid expansion and improvement of government health
services across the country is urgently required to redress low and
inequitable coverage and meet increased demand.

The report finds much cause for optimism in a context of strong political
commitment to health, including the introduction of free health care for
pregnant women, and the potential for significant increases in health
spending.

Through savings, an improvement in the quality of health aid but primarily
improved progressive taxation of Ghana’s own resources, especially oil, the
government could afford to increase spending on health by 200%*, to US$54
per capita, by 2015. This would mean the government could deliver its own
promise to make health care free for all - not just the lucky few at the
expense of the many.

The executive summary and full report are available at: *Achieving a Shared
Goal: Free Universal Access to Health Care in Ghana*
http://www.oxfam.org.uk/resources/policy/health/achieving-shared-goal-free-healthcare-ghana.html


*Note: In real value terms we argue the Government of Ghana spent $18 per
capita in 2008 rather than the reported $28 per capita due to 36% of
government expenditure being wasted through inefficiency, cost escalation
and institutional conflict.
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