The Health Insurance Service Providers Association of Ghana (HISPAG) has served notice to join the Christian Health Association of Ghana (CHAG) to turn away National Health Insurance Scheme (NHIS) cards holders from July 2.
The Director of Operations and Communication of HISPAG, Anthony Ameka threatened that “we may join the CHAG if the NHIA is unable to address the issues raised by the CHAG by 2nd July.”
The Health Insurance Service Providers say the payment for services they provided have been in arrears for eight months.
This was contained in a communiqué after a three-day meeting in the Kumasi in the Ashanti Region.
According Mr. Ameka, despite the Health Ministry’s earlier assurance that it will resolve their outstanding issues it has not made any such attempt yet.
“The ministry has not engaged service providers for any discussion up to date” said Mr. Ameka
Below is the communiqué
COMMUNIQUÉ ISSUED AT THE END OF STAKEHOLDERS MEETING OF THE HEALTH INSURANCE SERVICE PROVIDERS ASSOCIATION OF GHANA (HISPAG) HELD FROM 26TH TO 28TH OF JUNE, 2014 AT DICKSON HALL, ANITA HOTEL, EJISU
The National Health Insurance Scheme (NHIS) is unquestionably one of the best pro-poor social intervention mechanisms rolled out in Ghana. This is reflected generally in the ever increasing accessibility figures captured at our health facilities throughout the country. Indeed this is in line with the equity values and the resolve of Health Insurance Service Providers to ensure universal access to quality healthcare to all residents of Ghana. We further acknowledge Government’s determination to introduce innovative ways of managing the scheme in spite of financial challenges confronting it.
2. THE PREVAILING SITUATION
Regrettably, the National Health Insurance Authority (NHIA) has repeatedly delayed in payment of claims to service providers nationwide and is currently indebted to some of our member institutions, for an average of 7 to 8 months, a situation being witnessed by some health service providers in parts of the Ashanti, Upper East and Northern Regions.
Also worthy of note is the fact that the current NHIA tariffs are low, that is below the market prices of required inputs for services. Review of tariffs for services and medicines also take too long. For instance, medicines tariffs were last reviewed in March 2013 and that of the Ghana-Diagnostic Related Groupings (G-DRGs) as far back as 2012.
None of the tariffs have kept pace with the increasing rate of inflation. The low tariffs coupled with delayed payment have resulted to significant financial challenges to service providers, making it nearly impossible for the service providers to remain financially viable. The situation is further compounded by the recent introduction of VAT of 17.5% on the cost of medicines which is not reimbursed by the NHIA.
The current capitation payment model is also defeating the National policy on primary health care and reducing geographical access to quality health services in remote and hard to reach communities because the clinics located there are unable to continue to provide services.
Additionally, there is no functional contract between the NHIA and service providers; the relationship between the two parties has been premised on good faith and the desire of both parties to ensure the availability of quality healthcare to the people of Ghana. This has been to the detriment of service providers since the NHIA assumes no liability for not fulfilling its part of the partnership scheduled payments and economic tariffs.
Similarly, the present Act 852, Act 2012 has no regulation to guide its implementation.
The NHIA follows a differential payment schedule in reimbursing service providers a situation in which some provides are far ahead of others in terms of payment. For example service providers in the Bawku Municipal are far behind their counterparts in the Upper East Region when it comes to reimbursement because the other districts submit their claims to their district schemes for vetting and payment while those in Bawku Municipal are made to the Claims Processing Centre (CPC) in Tamale.
HISPAG notes that biometric authentication machines are been supplied to service providers who are been levied GH₡ 200.00 as monthly maintenance fee.
3. IMPACT ON FACILITIES
The current situation has culminated into the following:
- The hospitals and clinics are financially stressed and unable to meet their financial obligations, particularly, the payment of salaries in private facilities and other non-mechanized staff in CHAG and Government facilities;
- There is increasing shortage of essential drugs and medical supplies due to suppliers of these items legitimately refusing to grant further credit to service providers owing to non-payment of outstanding bills;
- Patients are left with no option but to take prescriptions to purchase medicines, even in emergency situations, from pharmacies and other outlets outside the health facility, thus compromising the delivery of effective and efficient quality of care;
- Hospitals/Clinics are resorting to bank overdraft facilities for funding of essential medical supplies against unfavorable bank interest rates, making the actual cost of services to increase. These additional costs are not captured by the NHIA tariffs;
- Hospital Managers are continuously being harassed by their creditors and often threatened with court actions;
- The quality of health services provided by health institutions is being compromised, much against our avowed commitment to provide the highest quality of care.
4. RECOMMENDATION TO THE GOVERNMENT
HISPAG makes the following recommendations to the Government of Ghana in respect of the current circumstances confronting the National Health Insurance Authority and service providers.
- We add our voice to the position of CHAG and call on the Government of Ghana to as a matter of national emergency find money to defray all outstanding claims owed to service providers up to April 2014, failing which other service providers will consider joining CHAG facilities NOT to recognize the National Health Insurance Scheme membership card as a means of payment.
- The National Health Insurance Fund (NHIF) was set up to mobilize resources for the efficient management of the national health insurance scheme. It is however regrettable to gather that, funds are usually not fully released, and when the releases are eventually made the process is fraught with many delays, making it impossible for the NHIA to settle claims promptly. Section 52 of Act 852 requires the Minister of Finance to cause all collections for NHIF to be paid within 30 days to the fund. HISPAG is saddened by the apparent lack of clear commitment by government to adhere to the dictates of the law. We are dismayed by this recurrent situation which is a source of great frustration to health managers and is slowly causing the collapse of our health institutions. HISPAG requests that the receipts from the NHIL be limited solely to the NHIF as required by section 42 (1) of the NHIA Act 852 and be used purposely for financing the NHIS as was originally intended.
- HISPAG urges government to explore other means of increasing the revenue base of the NHIA to make it financially sustainable.
- We do hereby call on the Minister of Health to also take immediate steps to establish the adjudication committee of the NHIS as required by the section 106 of Act 852. This would facilitate the speedy adjudication of cases between service providers, subscribers and the NHIA.
- That Section 108 (1) (m) of the NHIA Act 2012, Act 852 requires the Minister to make Regulations on the advice of the Board, by legislative instrument and make Regulations to provide procedures for the resolution of complaints and disputes by the Adjudication Committee and for receipt of feedback by the committee;
- HISPAG takes due cognizance of the efforts being made to roll out the reviewed tariffs for drugs and G-DRGs. We hereby petition the NHIA to make the effective date for the implementation of the new tariffs take retrospective effect from 1st June 2014, as service providers have already suffered a lot of losses due to disparity between tariffs that the NHIA has been paying and the prevailing market prices of drugs and related items.
- HISPAG calls for expeditious development and introduction of regulation to guide the implementation of Act 852.
- If the NHIA finds it necessary to supply biometric authentication devices to aid their work, the devices should not be provided at the expense of the Service Providers.
Our duty to provide health services remains paramount to us. From the National Health Insurance Act 852, we appreciate that the client has already paid for his/her care through the NHIL and direct payment of insurance premiums. We note with serious concern the inability of the NHIA to meet its commitment and obligation to pay for services rendered to its card bearers by service providers. This is causing hardship to service providers and limiting the availability and accessibility to quality healthcare to the clients we care for.
Under the prevailing situation, service providers may be unable to continue to recognize the NHIS membership as a means of payment for services rendered to clients. This notwithstanding, all clients who deserve emergency services from service providers across the country will be attended to and given the right care.
It is the fervent hope and belief of HISPAG that the issues brought to the fore and recommendations offered will be seriously considered and promptly addressed by the Government in the interest of all people living in Ghana.
By: Magdalene Larnyoh/citifmonline.com/Ghana