Why the Cost of Healthcare Will Never Decrease — and What Ghana Must Do About It

The cost of accessing healthcare is not going to decrease—because, quite frankly, that’s not how the system has been designed. This reality raises an urgent question: How do we finance equitable and sustainable healthcare delivery in a system built on rising costs?

More than a decade ago, Dr. Paul Farmer of Partners in Health proposed progressive universalism—a financing strategy that prioritizes the poor and vulnerable in the journey toward universal health coverage (UHC). His idea gained traction after his visit to Sierra Leone during the Ebola outbreak, where a failing health system contributed to the loss of thousands of lives, including a large portion of the country’s healthcare workforce.

The way a government chooses to finance healthcare significantly influences both the accessibility and quality of services. Financing mechanisms determine whether care remains a privilege for the few or becomes a right for all. The World Health Organization (WHO) has long emphasized the need for risk protection in health financing—a principle that remains essential in assessing the performance of any health system.

Ghana’s Journey Toward Universal Health Coverage

Ghana, like many developing nations, faces significant financial hurdles in achieving UHC. The National Health Insurance Scheme (NHIS) has seen some progress—increasing from 10.8 million members in 2018 to over 12 million in 2019. By 2021, around 16.75 million Ghanaians were enrolled in the scheme, representing approximately 54% of the population.

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This rise in enrollment reflects a collective hope: that NHIS will ease the burden of out-of-pocket healthcare costs. However, that hope is continually challenged by the scheme’s limited coverage and structural inefficiencies.

Before 1969, Ghana’s health system did not impose catastrophic spending on its citizens. But the introduction of user fees changed the narrative, making healthcare financially inaccessible for many. Since then, various financing strategies have been introduced, yet protection for the average Ghanaian has remained inadequate.

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The Gaps in Our Focus

Despite the evolving landscape, Ghana’s focus has not consistently aligned with the core goals of a functioning health system: improved health outcomes, financial protection, and equity. In our bid to reach UHC, we have overlooked the impact of voluntary membership and inconsistent contributions—two factors that threaten the sustainability and effectiveness of NHIS.

Across public health facilities in the Kumasi Metropolis, patients seeking diagnostic services frequently face exorbitant costs, especially for services not covered by NHIS. This discourages early diagnosis, increases the burden of illness, and ultimately leads to greater economic strain on both individuals and the nation.

To fix this, we must get our priorities right.

A Strategic Path Forward

Here are five proposals to strengthen Ghana’s health financing model:

1. Indirect Taxation on Harmful Products

Ghana’s large informal sector makes tax-based revenue collection challenging. One way to navigate this is to impose indirect taxes on products that pose health risks—such as alcohol, sugary drinks, and tobacco. These taxes can simultaneously reduce consumption and generate revenue for the health sector.

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2. Dedicated Funds for Exempt Groups

Currently, groups such as pregnant women and the elderly are exempt from paying premiums, as per NHIS regulations. However, this exemption puts immense pressure on already limited resources. The solution? Establish independent funds outside of the NHIS premium pool to specifically support these vulnerable groups.

3. Addressing Chronic Disease Risks Through Taxation

The rising burden of chronic diseases, many of which are linked to tobacco and alcohol use, demands a proactive approach. Higher taxes on these products would discourage use and provide additional funding to support chronic disease prevention and treatment programs.

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4. Introducing a Sanitation Tax

Poor sanitation contributes significantly to disease prevalence. A novel sanitation tax could not only serve as a corrective measure for environmental offenses but also as a revenue stream for health initiatives targeting underserved communities.

5. Increased Government Investment in Health

Ultimately, health is a public good and must be treated as a national priority. Government must commit to investing in special health development funds. A healthy population is the foundation of a strong economy—there’s no greater return on investment.

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Conclusion

Healthcare costs may never go down, but the burden doesn’t have to remain unbearable. Strategic financing, guided by equity and inclusivity, is the path forward. Ghana has the potential to lead the way in Africa, but only if we rethink our approach and prioritize health for all—not just the few.

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Let’s move beyond mere policy talk and begin building a system that delivers on its promise.

By Pius Amponsah Anane, a health systems research and management expert, Founder at Maries Cancer Foundation.