All NHIS claims to paid in November

ALL outstanding claims due service providers under the National Health Insurance Schemes (NHIS) will be paid by November, the Chief Executive Officer of the National Health Insurance Authority (NHIA), Mr Sylvester Mensah has said.
In addition, the CEO said currently, a system was being put in place to ensure that claims were paid within 30 days after their submission by the various District Mutual Health Insurance Schemes to the authority.
He explained that a technical team from The Netherlands was designing a new claims management format to ensure early payment of claims.
Mr Mensah made these known at a stakeholders meeting organised at Dodowa for service providers which comprised managers of public and private health care facilities, the Christian Health Association of Ghana (CHAG) as well as pharmacies in the Greater Accra Region.
Mr Mensah said the NHIA had between January and June this year paid a total of GH¢142 million as claims to some providers throughout the country, adding that a lot more work was going on to ensure that the NHIS was sustained to continue providing quality and equal health care to all residents in Ghana.
Under the National Health Insurance Act 650 of 2003, the NHIA is a re-insurance entity. Article 76 states that “there is establishment by this Act of the National Health Insurance Fund, referred in this act as the Fund” with the objective of providing finance to subsidise the cost of provision of health care services to members of the district schemes.
Touching on the disbursement of the Fund, article 77 (2) (b) of the Act stated that it is to “reinsure district mutual health insurance schemes against random fluctuations on cost under conditions to be determined by the Council”.
The NHIA, therefore has the responsibility of going to the aid of individual DMHIS which are unable to pay their service providers from the periodic budgetary allocations given to them by the authority in addition to the premium they collect.
A Daily Graphic special feature on Saturday, September 12, 2009 indicated that reports of severe shortage of medical staff, high prices of drugs as well as late submission and payment of claims were inhibiting the smooth operations of the NHIS across the country, with the Western and Eastern regions providing, probably, the only exceptions.
As our news team gathered from the regions, while the scheme appears to be making some progress in the Western and Eastern regions, the biggest challenges are in the Volta and Northern regions as well as in some parts of the Greater Accra Region.
Answering questions from participants, Mr Mensah said a new drug list would be available by October, adding that a review team tasked to work on the list had already completed its work which was currently going through fine tuning.
He stated that since the cost of drugs alone constituted more that 60 per cent of the cost of running a scheme, care must be taken to check any anomaly which might occur.
On the issue of one-time payment of premium, he stressed that nothing could change the government’s resolve to implement that decision.
He explained that an initial report presented by the International Labour Organisation indicated that the project was feasible.
The Project Coordinator of the Health Insurance World Bank Project, Alhaji Limuna Mohammed Muniru, said there were plans to provide more computers to providers to ensure efficient data entry in the facilities.
He also explained that the free maternal care introduced in July, 2008 was part of the NHIS and urged the service providers to encourage pregnant women to register with the schemes to enable them enjoy health care services after delivery.
The Ghana Health Service Focal Person on HNIS, Mr Phillip Akanzinge, complained about the increase in incidents of severe malaria in out patients departments throughout the country.
He wondered why there such records and at the same time reports indicated that large numbers of Ghanaians had been provided with insecticide treated nets, adding that it was possible that some of the providers recorded severe malaria in order to charge high fees which went against the schemes.