As such, assessing the state of health care and the National Health Insurance Scheme (NHIS) in particular remains critical.

Access to health care has increased substantially and the number of outpatient utilisation of the health insurance has risen from 597,000 in 2005 to 29.6 million in 2014. This means a collapse of the scheme which was introduced in 2003 as a financing mechanism and interventionist approach to promote universal access to quality basic health care, could adversely affect the poor and vulnerable if they are cut off from accessing free health care.

In spite of the gains from the scheme for the poor and vulnerable, the NHIS faces challenges that threaten its core objectives, efficiency and sustainability.

IEA Survey

In March 2017, the Institute of Economic Affairs (IEA) undertook a telephone survey to gauge the opinion of Ghanaians on what they considered to be the most pressing issues to be addressed by the government.

A nationally representative sample of 1,641 respondents selected from all 10 regions of Ghana were interviewed using the Random Digit Dialling (RDD).

Improve NHIS

In the health sector, the findings of the survey suggest that a majority of Ghanaians (57 per cent) expected the government to give the most important priority to improvement of the NHIS system in 2017. Indeed, this comes ahead of enhancing the quality of health care (22.2 per cent) and construction of more hospitals to improve access (20.8 per cent).

Chief among the factors that contributed to inefficiencies in the NHIS system, which threaten its sustainability, are delays in reimbursement of health service providers; poor quality of healthcare services in approved health centres and weak human resource capacity.

Other factors include fraud and corruption, low premium payments, increasing costs of reimbursement and false claims submitted by some approved healthcare providers.

Recommendations

The survey report outlines several recommendations relating to the NHIS. First, the IEA recommends a comprehensive review of the NHIS in order to improve understanding of the bottlenecks that have stalled the smooth running of the scheme.

Second, reassessment of the exemption list and extension of the tax base is proposed as a measure to ease the financial burden related to the rising cost of health care. In this regard, the report recommends that only the most critical health needs of citizens should be identified and earmarked for exemption.

Finally, the report suggests that instituting systems to strengthen monitoring and fraud detection will have to take centre stage.

An improved and efficient health insurance scheme remains integral to the provision of equitable access to basic health care. Overall, this has the strong potential to improve the quality of life for all citizens.