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President John Dramani Mahama has endorsed plans for a comprehensive review of the entire National Health Insurance Scheme (NHIS), which has been bedevilled with funding and operational challenges.

The review would critically look at the causes of the various challenges and how best to resolve it in order for the NHIS to serve subscribers better.

Critical proposals to be examined during the review includes rationalisation of the benefit package, review of exchange regime, consideration of global budgeting strategy, introduction of framework contracting for pharmaceuticals, and sources of funding.

The Finder can report that Health Minister Alex Segbefia is expected to make this major announcement in the next few days.

Information gathered by The Finder indicates that the blanket exemption of persons 70 years and above and persons 18 years and below, as well as pregnant women is too broad and unsustainable.

Sources say some persons 70 years and above as well as some pregnant women have the capacity to pay for healthcare and, therefore, do not need to be exempted.

In addition, some pregnant women also do not need the exemption, and as a result, the review would be looking at how best to identify persons who are vulnerable and target exemption at such people.

One controversial review being considered is the proposal by the Chamber of Pharmacy Ghana and others that NHIS should be limited to primary healthcare while individuals cater for conditions above primary healthcare.

This position is strongly opposed by some other persons who argue that limiting NHIS to primary healthcare would be to the disadvantage of the genuinely poor and vulnerable.

Apart from the premium paid by members, the scheme receives regular funding from central government.

This central government funding is drawn from the National Health Insurance Fund.

Also, every Ghanaian worker pays 2.5% of their social security contributions into this fund and an additional 2.5% Value Added Tax (VAT) also goes into the fund.

However, a proposal has been tabled to increase the VAT component to 3.5% instead of the current 2.5% VAT proceeds.

Every month, revenue that accrues to the National Health Insurance Authority (NHIA) on the average is around GH₵60 million but claims amount to about GH₵90 million, leaving a deficit of about GH₵30 million every month.

Consequently, for a 12-month calendar year, the scheme records a deficit of GH₵360 million.

In 2014, the NHIA paid claims of GH₵1.077 billion. Last year, the scheme registered GH₵10.545 million subscribers and whose hospital attendance put together hit 29 million.

Services offered under NHIS include:
•Out-patient services – general and specialist consultations reviews, general and specialist diagnostic testing, including laboratory investigation, X-rays, ultrasound scanning, medicines on the NHIS medicines list, surgical operations such as hernia repair and physiotherapy.

•In-patient services – general and specialist in-patient care, diagnostic tests, medication-prescribed medicines on the NHIS medicines list, blood and blood products, surgical operations, in-patient physiotherapy, accommodation in the general ward and feeding (where available).

•Oral health – pain relief (tooth extraction, temporary incision and drainage), dental restoration (simple amalgam filling, temporary dressing).

•Maternity care – antenatal care, deliveries (normal and assisted), Caesarean section, post-natal care.

•Emergencies – these refer to crises in health situations that demand urgent attention such as medical emergencies, surgical emergencies, paediatric emergencies, obstetric and gynaecological emergencies, and road traffic accidents.