Health economist recommends mandatory pre-payment for health insurance

A health economist, Professor Diane Mcintyre of the Health Economic Unit of the University of Cape Town, South Africa, on Wednesday recommended that mandatory pre-payment be the core of achieving universal access.

She said in Africa, out of pockets payment and voluntary pre-payment that are being practiced, have proved not be successful and did not allow for financial protection.

Speaking on the theme “Issues and expectations of African States in leveraging universal health coverage”, Prof. Mcintyre said there was the need for Africa to implement the mandatory pre-payment since most of the population that contributed to the health insurance are the people in the formal sector, which constitute a small proposition.

“If it becomes mandatory, then both the informal and formal will contribute for the benefit of all”, she said.

The congress, the first of its kind is under theme “Creating a Movement for Universal Coverage in Africa through Health Insurance” and supported by the Rockefeller Foundation and World Health Organisation.

It will initiate dialogue between government ministers, stakeholders and experts on policies which aims to strengthen and expand National Health Insurance Schemes in Africa.

The Congress will also provide an opportunity for international agencies such as the World Bank, the World Health Organisation, UNAIDS and GIZ.

Prof. Mcintyre said for such a scheme to work, countries should be bold to improve tax collections and compliance, and look for innovative health financing by imposing taxes on the mobile phone companies and create new tax or mandatory contributions in the formal sector.

Countries, she said, could also surcharge on income tax and not only on payroll for the formal sector and admitted that Africa had a discourse and informal sector had a large proportion of the population that needed to be captured.

“Evidence from Ghana and Tanzania show that mandatory is possible and indirect taxes are more possible and progressive”, she said.

She said it was essential to have cross-subsidies and called for the need to focus on the goals of reforms, adding, “We need to create fiscal space to pursue innovative financing as we open debate and an evidence-based on how to raise revenue for those outside the formal sector”.

Mr Sylvester Mensah, the  Chief Executive officer of Ghana’s National Health Insurance Authority who spoke on the theme “Health Insurance as an innovative Financing Mechanism, the Ghana Example” said Ghana’s health insurance had come a long way and was established by an Act of Parliament in 2003 (ACT 650) in response to the challenges of “cash and carry” system .

He described the insurance system as “very innovative and unique because of its tax-based financing, social health insurance, community–based and the earmarked funds constituted over 83 per cent of the total inflows.”

He said to ensure financial sustainability  of the scheme, the Authority was putting in measures such as cost containment and additional funding sources and these would look at clinical audits, consolidated premium account, electronic claims, increase in levy on petrochemical industry, review of the national health Insurance levy exemptions policy as well as road fund.

Mr Mensah said numerous challenges facing the scheme included inability to pay premium, clinical audit findings, financial sustainability of the scheme, ICT challenges and delays in submission of claims by some service providers.

He said there was the need to link treatment to diagnosis to improve efficiency and quality of care, introduce capitation as additional payment  mechanism and that would begin in Dcember.

He said the Authority will by next year establish two additional Claims Processing Centres as a way of consolidating claims processing to further improve efficiency.

Source: GNA

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