Medicine Financing: NHIS and other financing options

by Daniel Kojo Arhinful Research Fellow, NMIMR

Senior Technical Advisor, MeTA Ghana

MeTA~Ghana CSO/Media Orientation International Press Centre, Accra

16th April 2009

Outline

The ATM context Medicine financing issue Options of Medicine financing MeTA and NHIS Challenges of NHIS What MeTA brings to medicine financing Role of Media/CSO

What is the ATM problem?

Poor people lack access to essential medicines Prices are too high (private sector) Products are not available (public sector) Concerns about quality of products (public and private)

Need to focus on distribution from ‘port to patient’.

Manufacturer Procurement Agent (s)

Wholesaler Distributor Retailer / health unit

Patient

What is medicine financing about?

Making life-saving medicines available, affordable and equitable for poor countries; for poor people• Its about ways to reduce pharmaceutical

prices in low-income countries

• How to increase financing so that the poorest people can obtain necessary medicines and healthcare

Mechanisms for assuring EM

Availability of essential medicines at affordable prices can be assured through mechanisms such as:• Price information

• Price competition

• Bulk procurement

• Generic policies

• Equitable pricing

• Reduction or elimination of duties and taxes and

• Local production of assured quality amongst others.

Principles of medicine financing

Equitable access to essential medicines for priority diseases is a requirement for fulfilling the fundamental right to health.

Sustainable financing for essential medicines must be viewed in the context of overall healthcare financing.

Medicines financing options

Increased public funding via general tax revenue

User fees (cost sharing/cost recovery) Health insurance

• Social

• Community

• Private Donor Funding Medical Savings Account

History of health care financing in Ghana

Colonial period = Free for civil servants; nominal fee charged to non-civil servants PF

Immediate post independence = Fee free PF Seventies = Nominal fee CS/PF Mid eighties = Full cost recovery for drugs – era

of cash and carry CR Mid to late nineties = Health insurance pilot CHI 2003 = National Health Insurance SHI

What is the MeTA – NHIS convergence? - 1 Vision of Health Insurance Policy:

• Assure equitable universal access for all residents in Ghana to an acceptable quality of essential health services i.e 95% coverage.

Goal:

• Replace “Cash and Carry” with a minimum health care benefit package at the point of service

Policy objective: Within five years (from inception), every resident of Ghana shall

belong to a health insurance scheme that adequately covers him or her against the need to pay out of pocket at the point of service use in order to obtain access to a defined package of acceptable quality of health services

What is the MeTA – NHIS convergence? - 2 Super goal of MeTA for Ghana –

• To improve health outcomes for all people living in Ghana especially the poor.

Primary goal of MeTA• To support national efforts to enhance transparency in the selection, regulation,

registration, procurement, distribution, sales and rational use of medicines in Ghana.

NHIS as a medicine financing option offers significant opportunities to improve transparency, accountability, pricing, quality.

Common NHIS-Meta Principles

Commitment to improving health

Comprehensive approach to health systems, including pharmaceuticals

• Weak pharmaceutical systems result in poor access, quality, affordability and health outcomes

Transparency and accountability can:

• Improve system performance

• Build confidence

• Support equity and social justice

Multi-stakeholder approach

NHIS dilemma

NHIS offers significant opportunities to improve transparency, accountability, pricing, quality yet there are also huge challenges for achieving.

Policy challenges

• Poor coordination among stakeholders and lack of concrete governance arrangements and responsibilities for NHIS implementation leading to problems as:• fragmented tariff schedules and non-standardized

medicines lists which limit Providers’ control over their main cost drivers;

• gaps between the Information and Communication Technology (ICT) of NHIA & providers

• Weak Provider performance incentives;

Implementation challenges

Delays in issuing Health Insurance Identity cards to those who are registered.

• Registered members versus card holders

Lack of adequate technical tools for processing and reimbursing claims

• Claims = 4 weeks; Reimburse = 2.5 months.

Insufficient administrative, managerial, and technical human capacity

• Schemes lack skill; providers over-loaded

Non-standardized scheme operations

Financial sustainability challenges

Rapid implementation to show results• No control mechanisms in place to prevent

excessive use of health care services; Benefits package includes 95 percent of

all illnesses• Exemption policy creates incentives for

greater enrolment of exempt these policies further strain the financial sustainability o f the NHIS.

Socio-cultural challenges 1

NHIS viability is influenced by public approval. • Although NHIA has focused increasing public

awareness to encourage registration but poor public understanding of how the system works

• Endangered public opinion

• Frivolous and unnecessary demand and use of services both providers and users

• Some negative media coverage also creates problems

Difficulties of effective coverage for the poor and exempt indigents

Role of Media & CSO in promoting medicine financing and access - 1

CSO and Media must nurture an active and sustained interest in medicine financing through the creation of strong linkages both vertically and horizontally to influence policy and implementation issues

CSO and Media must seek adequate and appropriate education and understanding of principles underlying and achieving medicine financing such as social insurance to enable them effectively assist and/or undertake public education with other stakeholders

How will MeTA help to achieve medicine financing in Ghana

Delivering greater transparency through a systematic disclosure regime involving all relevant stakeholders – MeTA forum

Building accountability • MeTA provides mechanism to address cost

containment and scope for fraud under NHIS reimbursement –NHIS a key vehicle for the collection and disclosure of medicines data in Ghana and a principal user of such data

• Capacity building - broad range of CSOs and media - feed through to public understanding

• Peer oversight across health professions

Role of CSO’s and Media - 2

CSO/Media should use collective power positively to engage policy makers and programme managers and to enable them monitor and influence policy decisions on medicine financing

CSO/Media should pursue sustained knowledge on issues of access to medicines to influence activities in the area in order to meet public expectations of their traditional role as watch dogs of public good

Key Messages

NHIS is vulnerable to fraud due to inefficient record keeping and analysis, weak control systems

MeTA provides opportunity for pricing and quality monitoring mechanism to inform the NHIS

Media and CSO’s has an info-mediary role in fulfilment of MeTA goals

END

Thanks for attention and STAY

BLESSED