The National Health Insurance Authority (NHIA) is concerned about what seems to be a misinterpretation of data and other related issues appearing in its reports, and which issues have attracted media attention for some time now.
One such concern is the inference that rising NHIS utilization is an indication that people are getting sicker.
Literature on utilization of health services worldwide indicates that improved access to healthcare, such as Ghana’s NHIS provides, leads to increased utilization of health services.
Health Service utilization is affected by several factors including financial and geographic access to the service. With the onset of insurance, utilization in Ghana has consistently increased when people are insured. There are many research publications demonstrating this effect.
It is an effect which is related to the removal of the barrier created by out of pocket user fees (cash and carry) rather than because people have become “more sick”.
Here in Ghana, a policy document, which laid down the rationale and the framework for the establishment of the NHIS, titled “National Health Insurance Policy Framework for Ghana: Revised Version” published by the Ministry of Health in August 2004, noted that the introduction of user fees in the 1980s resulted in the first observed decline in utilization of health services in the country, a situation that the NHIS was designed to remedy.
Thus the document also acknowledges the role of health insurance in increasing utilization.
An increase in utilization within envisaged benchmark limits, following the implementation of the NHIS is not only an expected effect, indeed it is desirable. In the case of Ghana’s NHIS, two key factors have in no small way contributed to this.
These are the free maternal care policy that allows 6 antenatal and 2 post natal visits for pregnant women, and the G-DRG payment system that allows up to three OPD visits per episode of sickness.
Indeed, outpatient and inpatient utilization are key performance indicators in health systems globally. The outpatient utilization benchmark for more affluent countries is 5 visits per year.
The OECD average for outpatient utilization is 6.5 visits per year, which is more than double that of the NHIS. These benchmarks do not mean that these countries are “sicker”, but that access to healthcare, which spawns health seeking behavior, results in better health outcomes.
It is incontrovertible that the NHIS has improved health-seeking behavior among Ghanaians, accordingly the increase in utilization in the NHIS is envisaged.