Having been engaged with the Ghana health sector since 1996, I find it really encouraging that a (self declared) newcomer looks at NHIS as a glass half full! I was one of many so called experts advising against this scheme before the inception, and we were fortunately proved wrong! I have like Patricio been continuously impressed by the NHIS' innovations and its ability to address challenges. Yes, there are still many and difficult problems, some of which pointed out above, but not many back in 2003 would have dreamt that the scheme would be where it is only 10 years later. More happy birthday to NHIS and a big congratulation to Ghana.