I believe one of the good things to have happened to Ghana was the introduction of the National Health Insurance Schemes (NHIS). The evidence is clear; no nation has ever lifted itself out of abject poverty without a strong health care system. In fact this is intuitive – you need a healthy work force as well as a healthy citizenry to pursue a sustained development program. The NHIS is therefore a welcome policy in that it has the potential to offer much needed health services to the people of Ghana as well as raise the much needed funds to sustain the health sector. In fact if managed well, this policy has the potential to reverse the brain drain in the health sector. As the evidence points out, Ghana has been losing a lot of health professional to the western countries. Most of these health professionals are leaving Ghana because they are tired of the system. Salaries are low and equipments are outdated and inadequate. An insurance scheme has the potential to provide the necessary resources needed to pay realistic salaries to medical professionals as well as provide some of the cross cutting equipment and technology needed in the medical field.
However the proposal for only a one time premium payment for the NHIS is a sure way to bankrupt the scheme and make it irrelevant within a very short period. It seems the politicians are playing politics with this one too to secure votes. But this is one area that we just have to tell the people the truth. For once let us think about mother Ghana and do the right thing. It is obvious that no government no matter how rich will be able to provide FREE health care service. The Scandinavian and the British systems are the closest to a free health care service and in spite of all their riches, the scheme is fast threatening to bankrupt their economies. This is a matter of basic human behavior – any valuable thing that is free is over subscribed. That is why almost all insurance policies have a co pay – some negative incentive to prevent over use and abuse of medical insurance policies.
At present, Mr. Eric Ametor-Quarmyne, a Deputy Director at the NHIS says government currently finances 97% of the funds for the scheme while individual premiums make up only 3%. Now, that is really messed up. I don’t know why anybody should be happy about this. I get it, nobody likes to pay money, especially to the government. However, Government of Ghana cannot continue to be responsible for 93% or even 70% of the funds needed to run the NHIS scheme. Government of Ghana cannot sustainable finance the NHIS scheme at this level and at the same time deal with all the other critical issues of national importance. We have to know that the cost of medical care is not going to be static and as cost goes up so will the amount of money the government needs to pay to keep the scheme viable. Maybe the NHIS will only be providing funds for only malaria and diarrhea treatment. I don’t know why we think we have to depend on the government for everything. How can we enter the 21st century medical treatment and technology era if we are to depend on unreliable government contribution to our health care? We don’t want a scheme that will only treat small medical problems, but a program that will come through when we need it most to treat our life threatening conditions. Today, an average organ transplant cost $59,000 (GHC 82,000) per patient. Do we think the government will have the funds to be paying for these treatments on a regular basis? Nobody should tell me that organ transplant and other such medical treatments will be only isolated cases in Ghana. Gone were the days when we referred to chronic illnesses like diabetes, hypertension, renal failure, cancer and heart failure as the WHITEMAN’S diseases. Today, these diseases are very prevalent or fast becoming prevalent in Ghana. These diseases are usually associated with affluent countries. Although we are not that affluent, globalization has made a lot of the western lifestyles that make people prone to these diseases available in Ghana. It is now very common to find people in Ghana moving from their air conditioned homes to their air conditioned cars to their air conditioned offices. They are no longer walking in the sun and sweating, no exercise and yet they still eat all the fattened chicken, beef, unhealthy canned food and drink all the finest alcohol money can buy. Like the proverbial Fanti man, we are all now digging our graves with our mouths. If we want to live long and healthy lives, not only must we change our lifestyles we must also be ready to pay our share into the NHIS to make it more viable.
My brothers and sisters, I was amazed when I read about current technology on tissue allograft. I am sure a lot of you will be wondering what tissue allograft is. I am no medical doctor, but tissue allograft make it possible to transplant bones, heart valves, blood vessels, skin and tendons from the body of one person to another. Usually a person may donate his body after death or his next of kin may donate his body after death to harvest these body parts to benefit living persons who for medical reasons may need these parts. Can the government alone pay for all this? Of course not. But is it politically expedient to promise the people that all they need is a onetime payment to the NHIS system and the government will take care of the rest. The average person is instantly happy with such a proposal not knowing that his potential health care will be limited by what money the government can ‘afford’ to pay into the scheme. Yet when government officials are sick they are taken abroad to enjoy all the wonderful medical technologies at the expense of the tax payer. As if the life of a politician is worth more than that of an ordinary citizen. This is what I refer to as the Tragedy of Small Decisions. When people pandering to the politics of the four year cycle fail to make decisions that will benefit society in the long run.
The people of Ghana deserve to have access to the best medical technologies available in the world and it is obvious that a government financed NHIS system will not provide this. Let us therefore reject the onetime payment nonsense and embrace a fair recurrent payment system that will not be too burdensome on the people. This is my contribution.