The Health Insurance Providers Association of Ghana (HISPAG) has asked the National Health Insurance Authority (NHIA) to repackage its capitation programme and place more emphasis on education.
A letter addressed to the NHIA and signed by the Director-Operation and Communication of HISPAG, Anthony Ameka also asked the NHIA to review the charges for the programme.
The NHIA introduced the pilot capitation programme three years ago in the Ashanti Region.
The programme was introduced to reduce the supposed health insurance fraud around the country.
Parliament on Thursday March 27, 2014 directed the NHIA to review and report on the pilot program.
Parliament also directed that the NHIA replicate the capitation programe in the Volta, Upper East and Upper West Regions as well.
Mr. Ameka in an interview with Citi News revealed flaws the Association identified in the implementation of the capitation in the Ashanti region.
“We identified some challenges such as lack of stakeholders relationship during the implementation of the capitation in the Ashanti region.There was also inadequate or poor education for providers, and clients. Not only was the pilot duration undefined but the scope of capitation services was also undefined.” said Mr. Ameka.
The recommendations by the Association asked the Authority to among others educate and encourage clients to choose facilities closer to them.
Find below the full letter written by HISPAG.
THE CEO
NATIONAL HEALTH INSURANCE AUTHORITY
HEAD OFFICE
ACCRA
Dear Sir,
ROLL-OUT OF CAPITATION NATIONWIDE –MATTERS ARISING.
In accordance with Act 852, Act 2012 Section 37(d), the National Health Insurance Authority (NHIA) introduced capitation on pilot basis in Ashanti region in January 2012 as one of the payment mechanism. The aim was to (among others), improve cost containment; share financial risk between schemes, providers and subscribers; introduce managed competition for providers and choice for patients (compatible with portability) to increase the responsiveness of the health system. There were meetings with stakeholders (both public and private providers) prior to the start of the pilot. Key issues that took the centre stage in the various meetings were the capitation rate and services that were to be bundled into the capitation basket.
We acknowledge that there are obviously some advantages in capitation. The obvious advantage is the reduction in the ‘shopping around’ attitude of the clients. This surely has saved not only money to NHIA, but also saved prescribers precious time which could be used for serving others.
Another thing worth mentioning so far as the benefits are concerned is the payment of the capitation amount in advance to the facility. As you are aware, it takes several months for the Authority to reimburse the facilities with their itemized fees and the G-DRG. The advance payment really goes a long way to ‘cushion’ the facilities while waiting for the reimbursement.
Several platforms were created by the various interest groups such as Ghana Medical Association, Pharmaceutical Distributor’s Association of Ghana, Representatives of District Directors’ Group (Ashanti) among others requesting for the way forward for implementation of the Capitation. One of such calls wasat a press conference held in Kumasi on the 29th of January, 2014, by the Health Insurance Service Providers Association of Ghana (HISPAG) appealing to the National Health Insurance Authority (NHIA) /MOH to either embark on a nationwide roll-out of the Capitation Policy or suspend its pilot implementation in the Ashanti Region.
Furthermore, in a letter dated 17/2/14 to the Honorable Minister of Health and the Parliamentary Select Committee on Health, HISPAG have requested the Ministry of Health to immediately come out as to the way forward of the implementation of capitation scheme.
Again, on the 13/2/14, a Private Member’s Motion was raised by Honorable Dr. Richard Winfred Anane in the Second Session of the sixth Parliament of the Fourth Republic of Ghana “Order Paper” for the Eleventh sitting of the first meeting of Parliament stated” that this august House urges the Honorable Minister of Health to terminate the on-going Health Insurance (Capitation) programme being implemented by the National Health Insurance Authority in the Ashanti Region”
On the 15th of February, 2014, the Ashanti Regional branch of HISPAG wrote to the Regional Managerof the National Health Insurance Authority Ashanti Region – Kumasi copied all stakeholders with the capturing “Capitation pilot, delay in capitation payment and partial withdrawal of service” which requires all its member to effectively 23rd February, 2014 put on Red Bandson their wrest till 28th February, 2014 to express their disappointment and if the Honorable Minister of Health does not respond to their issues, then on 1st March, 2014, all Subscribers to the NHIA accredited facilities were going to pay cash for services to them; and /or NHIA subscribers shall be made to pay cash for the full cost of drugs supplied to them whiles they retain the cost of provision of services (e.g. OPD consultation etc) under the NHIA for reimbursement.
HISPAG recognizes the fact that there were, however, some challenges that affect not only the facilities but the health delivery system as a whole at its implementation phase in the Ashanti Region. The key amongst them is loss of revenue due to the low capitation rate. We are therefore calling for the review of the tariffs and lists to reflect the economic value in the provision of quality healthcare in the country.
Other challenges include:
1) Lack of stakeholders relationship .
2) Inadequate or poor education of providers, clients and National Health Insurance Scheme
3) Undefined pilot duration
4) Poorly or inappropriate defined scope of capitation services
5) Low per capita rate
6) Delayed payments of capitation fees
Despite the above challenges,HISPAG is extremely happy to note as per the Daily graphic publication date 21/2/14 titled ‘NHIS capitation operational in 3 more regions” and congratulate the NHIA on the bold decision taken to roll-out the Capitation scheme to three additional regions.
HISPAG wishes to recommend the following:
- That Capitation should be for primary care and clients should be educated and encouraged to choose facilities closer to them.
- National Health Insurance Authority and Providers should agree on capitation rate and benefit packages well as data for calculation of same Health facilities will require being upgraded and new ones established and provided with basic equipment’s, logistics and staff with skills to deliver quality benefit package to members.
- That Capitation scale-upshould be preceded with PPP (Family Hospital Concept) for a year or two before applying capitation rate.
- National Health Insurance Authority should package the capitation concept and the rate with emphasis on education to all stakeholders,
– Subscribers
– Providers
– Schemes / National Health Insurance Authority to fully understand the concept of capitation.
And that referral of patients / cases onto oneself before National Health Insurance Authority pay is laborious, time wasting, unethical, unprofessional and against our conscience
By A copy of this letter, we urge the Honorable Minister of Health to organise the stakeholder’s engagement meeting on the nationwide roll-out strategy of the Capitation implementation policy.
We wish to appeal to the NHIA to organize stakeholder’s consultative meetings with both public and private providers prior to the start of the capitation scheme in these three regions.
We are therefore with effective 25th of February, 2014, urge ALL HEALTH ISURANCE SERVICE PROVIDERS especiallythose in the Ashanti Region to suspend all intended actions until further notice.
HISPAG would want to repeat that our primary interests are to protect the patients /subscribers, to ensure good and quality health care for all and to advocate for the perpetual survival of the National Health Insurance Scheme.
Thank you
Yours Sincerely,
Anthony Ameka
Director – Operation & Communication
Cc:
The Honorable Minister of Health,
The Honorable Members of Parliament
All Health Insurance Service Providers
The Press
By: Magdalene Larnyoh/citifmonline.com/Ghana