Sanctions will ensure quality health care-NHIA

THE National Health Insurance Authority (NHIA) says its decision to sanction offending service providers and some individuals is not to tarnish their image, but to ensure that safe and quality health care is offered to the people of Ghana.
It said as the authority tried to encourage those who committed genuine mistakes in their operations to effect the necessary changes, those who indulged in criminality in order to gain from the National Health Insurance Scheme (NHIS) would be dealt with according to the law.
The Deputy Director, Operations of the NHIA, Mr Anthony Gingong, told the Daily Graphic in Accra that the authority would continue to monitor and evaluate the activities of accredited service providers under the NHIS till quality service was assured.
He stressed that the NHIA had the responsibility to manage the NHIS on behalf of all Ghanaians and, therefore, could not afford to allow the scheme to collapse.
The Deputy Director of Operations said there existed problems with many of the health care providers because the method used to engage them initially was an open one because it did not follow any guidelines, adding that many of them were accredited based on recommendations from some existing professional bodies without any standard guidelines.
He pointed out that now that the authority had come out with a written guidelines, it had to step in to sanction some of them because in some cases, they failed to do the right thing even after they had been provided with a working manual to enable them to effect changes.
He said monitoring and evaluation so far conducted revealed that some of them, for example, did not have the required number of health personnel and adequate treatment facilities, to enable them to render effective health care to subscribers.
“In one of the facilities that we visited, there was only one place of convenience for everybody, including men, women and children,” he pointed out.
Mr Gingong reiterated that some of the cases were criminal in nature and, therefore, needed to be investigated further and went ahead to cite an instance where a hospital charged a scheme for performing a Caesarian operation on a woman but later checks revealed that the said woman was only five months pregnant.
He observed that in almost all the cases, when those service providers who tried to cheat the system were exposed, they came up with the excuse that it was a mistake.
He took the opportunity to advise those individuals and groups who had made up their minds to wrongfully gain at the expense of the NHIS, to change their attitude since the authority would not allow that to happen.
The NHIA has since August, 2009 sanctioned a number of individuals and service providers who have allegedly misconducted themselves in the Ashanti, Volta and Brong Ahafo regions, where clinical auditing has taken place. Similar exercise is yet to take place in the rest of the regions.
The sanctions took the form of suspension of the affected service providers, interdiction of some NHIA staff and in some cases, the individuals involved were reported to the police.
Cases involving service providers who worked within the public sector or mission hospitals were reported to the Ghana Health Service (GHS) and the Christian Health Association of Ghana (CHAG) respectively for appropriate the action to be taken.
Allegations, which, according to Mr Gingong, included wrong prescription, lack of records covering claims, lack of appropriate facilities for effective operation, use of banned drugs, double billing and over-billing, professional misconduct, lack of appropriate health personnel and unhygienic environment, were levelled against the affected service providers.
The alleged offence of the personnel included malfeasance, misappropriation of funds and over-payment of claims, among others.