Steps to streamline District Mutual Health Schemes (Page 31)

CHALLENGES confronting the district mutual health schemes are expected to be solved this year with the introduction of a technology backbone into the operations of the schemes.
According to the National Health Insurance Authority (NHIA), with the new technology in place, about 60 per cent of claims received from the various healthcare providers nation-wide would be processed electronically at the regional centres to ensure early payments.
Claims are currently processed manually at the individual district scheme offices, a situation NHIA officials say accounts for the delays.
The authority has also stated that it will employ new personnel for the processing and payment of claims.
These were contained in a report of the Parliamentary Select Committee on Health on the 2009 Budget Estimate of the Ministry of Health.
The issue of delays in the payment of claims by the various DMHISs has been a major problem facing both the schemes and the healthcare providers, especially those under the Ghana Health Service (GHS).
On February 10, this year, the Daily Graphic reported that some of the 145 schemes nation-wide faced imminent collapse if the GH¢38 million they owed service providers was not paid by the end of the month.
That came out at a meeting in Kumasi at the beginning of January 2009 during which the service providers threatened to demand payment from insured persons before they would be taken care of and demanded the payment of all outstanding debts by the end of the February.
When he was contacted to comment on the issue, the Director-General of the GHS, Dr Elias Sory, confirmed the decision taken by the facilities.
The NHIA thereafter made attempts to help the schemes to offset some the debts.
In the report, the select committee identified the high cost of administration, unskilled personnel, the existence of numerous claim centres, as well as delays in the submission of claims, as some of the factors which affected the general efficiency of the NHIS.
It was, however, optimistic that with the introduction of the technology backbone into the operations of the scheme, most of the problems would be solved.
It called for holistic support in the achievement of the goals of the scheme, as well as intense monitoring and evaluation of the scheme to ensure efficiency.
The committee also called on the National Insurance Commission (NIC) to ensure that its percentage contribution to the NHIS for emergency service was released within the year to support the activities of the scheme.
In the same report, the committee called for the capturing of the National Ambulance Service (NAB) of the MoH under the NHIS to enable the service to obtain an adequate number of ambulances for its operations.
It said looking at the importance services the NAB rendered to the nation, there was the need for it be provided with adequate financial support to enable it to be more efficient.
It pointed out the NAB, as it stood at present, was working with inadequate resources and stated that the service had only 36 ambulances, a number which was inadequate to cover the whole country effectively.