The National Health Insurance Authority (NHIA) has extended the Capitation provider payment method to the Volta, Upper East and Upper West regions with beneficiaries of the Scheme selecting their Preferred Primary-care Provider (PPP).<\/p>\n
Preferred Primary-care Provider (PPP) is the healthcare facility a subscriber chooses to receive medical treatment anytime he or she is not well. The system allows for referrals to higher level healthcare facilities should the condition require.<\/p>\n
The PPP enrolment which began in the three regions on July 2, 2015, according to the acting Chief Executive Officer (CEO) of the National Health Insurance Authority (NHIA), Mr Nathaniel Otoo, will be rolled-out across the country by the end of 2015.<\/p>\n
[contextly_sidebar id=”HiNo5NL6Cwhq9yAMrYNnq7ZrWE28Rn4z”]In an interview with Mr Otoo, who until his appointment in June 2015, was the Deputy Chief Executive responsible for Operations, he said \u201cproviders in the three regions were expectantly awaiting the Capitation program as they have been properly educated and sensitized on it for almost a year now\u201d.<\/p>\n
One advantage of Capitation he said is that it guarantees the service provider a certain amount of money at the start of every month depending on the number of subscribers enrolled to that facility.<\/p>\n
The pre-payment of claims under capitation according to the acting CEO is an incentive which he believes makes it easier for service providers to forecast and plan their activities without worrying about delays in claims reimbursement from the NHIA.<\/p>\n
He also said the program will enable subscribers get better service from their selected PPPs as they could change their healthcare providers after every six months should they find treatment substandard.<\/p>\n
Mr Otoo informed that Capitation is a game of numbers and the providers may not gain much should their subscribers leave for other facilities which may be performing better.<\/p>\n
This phenomenon, he said helps to bring \u201cmanaged competition\u201d among healthcare facilities, with each striving to maintain and even recruit more subscribers.<\/p>\n
Capitation, which is one of the most effective and efficient healthcare provider payment systems, was implemented on a pilot basis in 2012 in the Ashanti Region. The scheme initially faced stiff opposition and challenge from healthcare providers in the region.<\/p>\n
The opposition faced, Mr Otoo conceded was due to the lack of adequate education and sensitization on the project in the region, a challenge he said was one of the lessons the NHIA learnt in the pilot.<\/p>\n
Ashanti region after the pilot, has since begun real implementation and the extension of the program to the Volta, Upper East and Upper West brings it to four regions in all implementing the new provider payment method.<\/p>\n
Under capitation, service providers are paid in advance, a pre-determined fixed rate to provide a defined set of services for each individual enrolled with the provider for a fixed period of time.<\/p>\n
The amount paid to the provider is irrespective of whether that person would seek care or not during the designated period and it covers only primary healthcare for out-patient attendance of patients.<\/p>\n
Making a key observation under the Capitation programme, Mr Otoo said it had made public and private healthcare services readily available to people.<\/p>\n
Giving statistics, he said so far 65 to 80 per cent of all private hospital attendants were NHIS card holders while 90 per cent of all attendance in public healthcare facilities were NHIS subscribers.<\/p>\n
Addressing matters of implementation challenges of NHIS, Mr Otoo said the NHIS has had a fruitful engagement with government and was therefore in the process of paying providers for February saying that this would put the scheme in arrears of four months.<\/p>\n
With a total active membership of 10,545,428, the service he said was bedevilled with the issue of quick escalation of prices of medicines, which are also subject to the general socio-economic environment. He said medicines constitute about 50% of total NHIS cost and the NHIA was working with the relevant stakeholders to improve the situation.<\/p>\n
Mr Otoo, who was instrumental in the review of the NHIS enabling law said, the scheme was coming up with a strategy to ensure a more cost efficient medicine regime adding that the introduction of capitation, would help stop people from shopping around for medicine.<\/p>\n
Speaking to the subject of financial sustainability, Mr Otoo said the NHIS currently had financial sustainability issues which according to him had been envisaged at the start of the scheme.<\/p>\n
He said with prudent investments, it had managed to cover some of its costs but as the number of subscribers kept increasing, it had become difficult for the scheme to keep up with its financial obligations.<\/p>\n
To this end, the NHIS he said was looking at ways to diversify and increase its sources of funding and was therefore exploring options such as linking up with telecommunications companies as well as banks who use their database for verifications to generate further resources to support the scheme.<\/p>\n
The NHIA boss said what the NHIS needed now was for it to be more proactive with its premiums and other revenue generating ventures. An enterprise he said he was ready to pursue with his team at the NHIA.<\/p>\n
Mr Otoo also underscored the importance of stakeholder partnerships to the NHIA. According to him, with the right alliances with relevant agencies, bodies and the general public, the scheme will surmount its challenges which it continues to grow and expand access to many more people.<\/p>\n
<\/p>\n
By: citifmonline.com\/Ghana<\/p>\n
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The National Health Insurance Authority (NHIA) has extended the Capitation provider payment method to the Volta, Upper East and Upper West regions with beneficiaries of the Scheme selecting their Preferred Primary-care Provider (PPP). Preferred Primary-care Provider (PPP) is the healthcare facility a subscriber chooses to receive medical treatment anytime he or she is not well. […]<\/p>\n","protected":false},"author":5,"featured_media":137846,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[],"tags":[15,38],"yoast_head":"\n