Feng Zhao

Huihui Wang

Enis BarÄ±ŠŸ

Rachel Silverman

Almost half a century ago, policy leaders issued the Declaration of Alma Ata and embraced the promise of health for all through primary health care (PHC). That vision has inspired generations. Countries throughout the world—rich and poor—have struggled to build health systems anchored in strong PHC where they were needed most. The world has waited long enough for high-performing PHC to become more than an aspiration; it is now time to deliver. The COVID-19 (Coronavirus) pandemic has facilitated the reckoning for that shared failure—but it has also created a once-in-a-generation opportunity for transformational health system changes. The pandemic has shown policy makers and ordinary citizens why health systems matter and what happens when they fail. Bold reforms now can prepare health systems for future crises and bring goals such as universal health coverage within reach. PHC holds the key to these transformations. To fulfill that promise, however, the walk has to finally match the talk. Walking the Talk: Reimagining Primary Health Care after COVID-19 outlines how to get there. It charts an agenda to reimagined, fit-for-purpose PHC. It asks three questions about health systems reform built around PHC: Why? What? How? The characteristics of high-performing PHC are precisely those that are most critical for managing the pressures coming to bear on health systems in the post-COVID world. The challenges include future outbreaks and other emergent threats, as well as long-term structural trends that are reshaping the environments in which systems operate in noncrisis times. Walking the Talk highlights three sets of megatrends that will increasingly affect health systems in the coming decades: • Demographic and epidemiological shifts • Changes in technology • Citizens’ evolving expectations for health care. Reimagined PHC systems will be equipped through optimized system design, financing, and delivery to ensure high-quality services, care to address patients’ needs, fairness and accountability, and resilient systems.

Reimagining Primary Health Care after COVID-19

Walking the Talk

Nathaniel Otoo

Lydia Dsane-Selby

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.

Improving Financial Sustainability Based on Expenditure Review

Ghana National Health Insurance Scheme

Huihui Wang

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