Transcript B5.2 Presentation at nhis conference

Sustainability of recurrent
expenditure on public social welfare
programs: expenditure analysis of
the free maternal care programme
of the Ghana NHIS
Presentation by:
DR EMMANUEL ANKRAH ODAME
PPME-MOH
Outline of Presentation
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Background
Methods
Results
Discussion
Conclusion
Acknowledgement
Acknowledgements
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Prof. Irene Agyepong
Dr Afisah Zakariah
Mr Sylvester Mensah
Mr. Nathaniel Otoo
Mr Ben Yankah
Dr Patricia Akweongo
Dr Francis Asenso-Boadi
Mr Emmanuel Owusu-Ansah
Background
• Sustainability of public social welfare
programs has been of concern in development
circles
• Free maternal care programme(FMCP)
launched with a start up grant in 2008 form
British Government
• The NHIS received US$20 million in 2008 and
US$10million in 2009, afterwards NHIS was
expected to fund it
Methods
• Retrospective and descriptive
• Relied on secondary data from a review of
routine health records of provider facilities
and the NHIS
• Study period January to December,2009 in
one sub metro
• It had all 3 levels of provider facilities(B,C,D)
• Data analysed with Stata version 9
Results
• 62% of all claim was for Antenatal care(ANC)
• 60% of claims was from regional specialist
hospital(RSH)
• Regional specialist hospital average claim
expenditure was higher than the overall average
• Average ANC claim expenditure was lower at the
RSH than at the Government polyclinic(GP)
• Average spontaneous vaginal delivery (SVD) claim
expenditure was higher at the Government
Maternity Home(GMH) than at GP and RSH
Results
• Total claims expenditure showed ANC as the
component with the highest claims expenditure
• SVD was the component with the highest claim
expenditure at the RSH
• British Government grant in 2009 was about half
the expenditure incurred in 2008 for maternal
health services
• In 2009,FMCP expenditure was 23% of the total
claims expenditure
• NHIA expenditure exceeded income in 2009,
giving a deficit
Discussion
• Impossible to create a health system free of all
tensions relating to financial sustainability
Financial sustainability are coming from several fronts
 Failure from onset to look at long term financial
sustainability
 International development partners should also be
responsible in promising financial guarantees
 Inadequate attention to claims expenditure cost
containment
 Lack of adequate attention to provider payment
mechanism
Discussion
• Gatekeeper system not being adhered too
• Medicines can be a major cost driver
• Levels of care and gatekeeper systems are
important cost containment mechanisms
Conclusion
• Avoid a dependency on donor promises to
replace careful long term fiscal evaluation and
planning
• Critical attention should be paid to issues of
strategic purchasing of the services
• There are incentives an disincentives inherent
in different provider payment mechanisms
• Careful attention must be paid to design with
this in mind