Policy makers in the health sector have been asked to consider the long-term factors of demography and increase in non-communicable diseases in its quest for sustainable financing for the health sector.

This is because sustainable healthcare financing could only be seen in the context of universal healthcare coverage which focuses on giving access to health services in a manner that is of good quality and does not lead to catastrophic expenditure.

Dr Gordon Abekah-Nkrumah, Senior Lecturer at the Department Of Public Administration and Health Services Management of the University of Ghana, said most views on ensuring sustainable financing, especially with the National Health Insurance Scheme (NHIS), focused on the short term approaches including how to increase financing by raising taxes or introducing new ones, while neglecting potential future issues that would affect health financing.

Dr Abekah-Nkrumah, who was chairing a Symposium at the 67th Annual New Year School on the topic “Sustainable Healthcare Financing”, said looking at disease patterns and age pyramid of citizens in Ghana, many deaths were caused by non-communicable diseases such as cancer, stroke, hypertension, and other cardio-vascular diseases which were very expensive to manage.

“It is important to begin to look at what is going to happen in the next 10 to fifteen years because those within the middle income bracket, around 35 to 40 years are those who have money to spend and are acquiring these diseases, they are also within the labour force and have sedentary lifestyles, making them predisposed to these kinds of diseases,” he said.

He said in the next 15 to 20 years such people will be the elderly ones who would be exempt from paying premiums to the NHIS but who are supposed to benefit from the service.

This, he said, would be a huge cost burden on the scheme and pose cost implications in terms of financing.

Dr Abekah-Nkrumah said “we need to begin to look at all these issues and factor them into our planning going forward, otherwise we are going to have a problem on our hands.”

Mr Sylvester Mensah, former Chief Executive Officer of the National Health Insurance Authority, said it is important to review the scheme and the President has set up a committee, to review the benefits and exemptions under it.

He said the exemptions under the scheme was considered as one of the most generous in Africa covering children under 18, adults 70 and above, Social Security and National Insurance Trust pensioners, indigenes, pregnant women, persons with mental disorders and categories of the disabled.

“Some of the exemptions do not make sense now, time has come for a radical review of the exemptions because some have the capacity to pay’” he said.

He said the scheme needed to be restructured to determine its sustainability as records showed that premium payments and other deductions were not enough to cover the scheme; especially the benefit scheme and exemption scheme.

He also called for an intensification of cost containment measures and collaboration with the Ministry of Gender, Children and Social Protection to improve common targeting mechanisms as well as enhance ICT services to cut cost.

Mr Dan Osei, Head of Budgeting at the Ministry of Health, called for the adoption of new and innovative sources of funding for the health sector.

He said there were alternative sources of health financing that were being used globally and this could be employed in Ghana to finance health services.

Mr Osei said models like Social Impact Bonds where investors pay an advance for health interventions to be paid back by those who enjoy the service, could be used.

Another way was to collaborate with banks who write off a lot debt at the end of every year, to have the debtors pay a small percentage (10 per cent) of the debt which will then be used to finance healthcare.

“They’re being used globally and there’s no reason why we cannot also use them,” he said, adding that increasing taxes only put more burden on the poor and vulnerable whom the scheme was trying to help.