Health insurance in Ghana has come a long way notwithstanding the number of issues faced by insurers in both the public and private sectors. Regardless of the experiences one may have had with Health Insurance, the benefits of having a cover far outweigh the demerits. In this article I will attempt to give ten reasons why every Ghanaian needs a medical insurance cover.
- The Laws of Ghana says so
The National Health Insurance Act, 2012 (Act 852) states in Part Two Session 27 clause 1 that a resident of Ghana shall belong to the National Health Insurance Scheme and may also belong to a private health insurance scheme. The framers of the law duly appreciated the importance of the ensuring that every Ghana has some health care cover so that in times of emergency they can get access to care. No one plans to get sick and in most cases, people in dire need of some critical care may not be able to afford the service.
Therefore in terms of the law, every person residing in Ghana is mandated to have some form of health insurance cover.
- Health care is a basic need for life just like food, clothing and shelter.
Health care is a basic need for all mankind. There are very few individuals who will live through life from infancy through adulthood and old age without ever visiting the hospital or needing the services of the health care practitioner. Human beings fall ill and get well. Persons without the opportunity of access to any form of health care invariably die from seemingly simple and treatable ailments and diseases.
Access to health care is a therefore a basic need and is so duly incorporated as part of the Sustainable Development Goals (SDGs) agreed by the world community. Goal 3 of the SDGs aims at ensuring healthy lives and promoting the well-being of all at all ages. This goals takes into cognizance the need to make health accessible, available and affordable for all humans at all ages. Having a form of health insurance cover creates the access aimed at in the above global objective.
- There is no way to predict the affordability of health care no matter how much money one has
The cost of health care services over the past 10 years has seen significant increases across the world. Deloitte and Touche in their “2014 Global Healthcare Outlook – shared challenges, shared opportunities” reported that the total global health spending rose by 2.6% in 2013 with a projected prediction of an average rise of 5.3% per year from 2014 to 2017. This significant health care expenditure is expected to place enormous financing pressures on governments, health systems, insurers and consumers both in the developed and the developing markets. The Economist intelligence Unit estimated global health care spending as a percentage of GDP in 2014 to be about 10.5%. The real percentages were about 17.4% for North America, 10.7% in Western Europe, 8.0% in Latin America, 6.6% in Asia/Australasia and 6.4% across the Middle East and Africa.
In addition to the above, cost of some health care services are recurring, especially for persons living with chronic diseases, the aged and those needing more sophisticated technologically driven medical and surgical procedures. Patients who fall into this category need a system designed to support them to make payments for these much needed care.
No matter how much one puts aside in savings, there is no way of predicting whether one’s personal savings can meet up the cost of health care at any point in time or not. Hedging against these real but unpredictable health care eventualities through a health insurance policy is a must for every living person.
- Health Insurance helps provide healthcare cover for the vulnerable masses in society
While acknowledging that health care services are expensive and every human being must contribute something to the payment for these services, societies are daily faced with the vulnerable population who have no means of affording health care. It is on this basis that social insurance policies are crafted to provide cover for individuals in this category not as a charitable service, but as an obligation placed on us by our humanity to care for less privileged. The National Health Insurance Acts provides for a category of persons who are exempted from the payment of premiums under the NHIS and this is a social financial shield for such persons well covered in the act.
As life expectancy increases globally, the need to make room for coverage for the aged who are usually saddled with a significant number of health needs cannot be over-emphasized.
- Health Insurance offers an opportunity for second medical opinion regarding therapeutic options.
Some services offered by health insurance providers requires pre-authorization. Pre-authorizations allows the managers of such insurance policies to review specific diagnostic and therapeutic requests made by health care practitioners before authorizing it. Reviews of these are done by competent team of medical experts who base their decisions on standard medical practice and the best cost-effective options available.
This procedure grants the patients an opportunity for a second opinion on the care proposed to them by a provider based on the medical necessity of the procedure, acceptable standard of medical and surgical practice and the costs associated. Lives have been saved in cases of wrong diagnoses or wrong investigation requests by medical practitioners, which is a real challenge of our current health delivery system.
- Health Insurance works and there are good statistics to prove that
Health insurance works and there are many examples to refer to. The UK despite all its problems is praised for its health insurance system that ensures access to every citizen. Ghana has also come a long way with its NHIS. Mention could be made of several countries like France, Germany, Ireland, Italy, Spain, Australia etc. Most of these countries have very functional social health insurance systems.
In countries without a social health insurance system, Private Health insurance comes in handy and works. There are several examples to cite in Africa notably South Africa, Egypt, Kenya, etc. For the corporate client who requires a good cover for its staff, enrolling unto a private health insurance scheme is known to have worked and provided the peace of mind needed by both employer and employees to ensure a healthy workforce.
Across the world, Health care providers can attest the ease of claims payments and refunds provided by health insurance companies. Health insurance works and has provided the lifeline to many who were in dire need of care in very critical moments of life.
- Health Insurance helps keep service charges under control
In its current form, most charges for health care services are fixed by service providers taking into account their cost of inputs, staff costs, technology employed in the delivery of care and other ancillary costs. It is estimated that the average medical inflation in Ghana for 2015 was between 40 to 50%. Looking at the volatility of our economy, a downward trend in this rise in medical inflation does not appear to be in sight.
Health insurance offers payers the opportunity to negotiate service charges with providers and in some cases allow for the use of cost containment approaches like capitation to manage the sky-rocketing health care costs. This when managed well, allows for the payment of significantly low premiums for wide coverage access to health care by persons enrolled onto health insurance, be it public or private.
For corporate firms, the only probability of predicting and hedging staff total health bills for the year is to purchase a health insurance policy for them. In a volatile market like that of Ghana, one needs to be able to plan to mitigate these staff health cost exposures.
- It helps increases service quality as providers compete for clients
In my years of medical practice, I have come to appreciate that sometimes the danger to patients is not their disease but the hospitals that treat them. Most health insurance systems have built-in service provider audits that allows for independent bodies to review the level of medical care being delivered to patients. These clinical audits ensures that patients gets the best of care in line with standard medical practice.
In well-functioning health systems, hospitals and clinics that consistently deliver below par services can be deleted from accredited provider lists and practitioners found culpable could have their licenses revoked for poor medical care delivery. These clinical audits allows for and Insurer – provider engagement, and this eventually leads to improvement in customer service levels at such providers outfits. Provider who deliver consistently high standards of care get recommendations for use by clients. This therefore creates a competition among providers to attract more clients with best customer service.
- It takes the administrative burden off the Human resource department, freeing staff hands for the employers core business
Most companies who are self-insured battle daily with the review of claims submitted to them by service providers. The lack in internal expertise to manage these processes leads several companies to incur and pay for medical services which hitherto could have been avoided.
Human resource staff are saddled with having to spend a lot of man hours processing refunds for staff and going through medical bills from service providers when they lack the basic understanding of the entire health delivery chain. Out-sourcing these processes to a health insurance company allows staff to concentrate on their core business.
- It is the future of Health care in Ghana
The NHIS has about 12 million individuals enrolled unto its health scheme. The private health insurance companies together provide coverage for about 350,000 employees and dependents of mainly corporate firms. With the private health insurance markets in Ghana getting sanitized, the possibility of private insurers crafting insurance benefits products aimed at extending coverage to individuals and families is very high. The private individual uninsured market space is a blue ocean yet to be explored and I foresee a great number of self-employed persons getting enrolled unto these private health plans.
Altogether, the above outlook predicts a growing number of persons using health insurance – either public or private – as their means of paying for health care services. This is the real future of healthcare delivery in Ghana.
There is therefore the need for players within the health care space to brace themselves up for a future where payment for practically all healthcare service will be done through a health insurance company. It has worked in several countries and it will definitely work in Ghana.
By Dr. Dan V. Armooh, BSc, MD, MBA, MPH
CEO, Acacia Health Insurance
The writer is the CEO of Acacia Health Insurance Ltd, a private commercial health insurance company. He can be reached on firstname.lastname@example.org