Results-based health financing, as introduced in Argentina, is a decentralized health financing system which incentivizes local authorities for achieving certain predefined and priority healthcare deliverables. Although, touted as a model for Africa, Ghana’s National Health Insurance Scheme (NHIS) has received a lot of criticism in recent years for being inefficient. This paper offers some lessons from Argentina for Ghana’s struggling NHIS.
Argentina’s Plan Nacer was introduced in 2004 with the purpose of ensuring a wider health coverage especially for the vulnerable. According to the Center for Global Development (CDG) Washington, D.C, the program provides incentives to provinces that enroll the uninsured, including women and children and improve related health outcomes. The federal program pays provinces 60% based on total enrollment on Plan Nacer. The remaining 40% is disbursed based on improvements in health coverage and outcomes, measured using audited administrative data.
A preliminary evaluation report delivered by the implementers of Plan Nacer at the CDG Headquarters in October 2013, indicates that coverage of health services such as vaccines, health checkups for children and counseling on reproductive health has increased. Again, waiting lists for health services have decreased and a significant impact on neonatal mortality has also being achieved.
Ghana’s National Health Insurance Scheme was introduced in 2003 with the aim of providing equitable access and financial coverage for basic health care services to Ghanaians. However, according to an Oxfam International report entitled: ‘Achieving a Shared Goal: Free Universal Health Care in Ghana’ published in March 2011, though every Ghanaian citizen pays for the NHIS through VAT, only 18% of the population are covered under the program. A huge membership gap exist, as 64% of the rich are registered compared with just 29% of the poorest.
The NHIS currently adopts capitation as the main provider payment method, a mechanism which typically pays health providers in advance irrespective of whether enrolled persons would seek care or not during a designated period. Drugs are however paid for through the Itemized Fee for Service payment method, whereby the provider is reimbursed for the cost of drugs administered.
With capitation, some providers are not paid in time so they turn away patients; providers who receive payment refuse to provide care and there is usually little accountability. Cost of drugs are also inflated through the Itemized Fee for Service method. These inefficiencies and corruption inherent in the NHIS is costing the health sector millions of Ghana cedis each year.
The success of Plan Nacer was dependent not only on money but on the culture of measurement and accountability that was built around the program. If the Ghana government incorporated Argentina’s Plan Nacer into the NHIS framework for instance significant cost savings could be achieved.