NHIS results in increased hospital attendance-study

THE implementation of the National Health Insurance Scheme (NHIS) has led to significant increase in attendance to health facilities without a corresponding improvement in health infrastructure, equipment and human resource.
The situation is said to have resulted in extra workload for health professional, over-stressed staff, excessive pressure on existing amenities and reduced attention to patients.
These came out at a dissemination workshop in Accra yesterday on the findings of a research on "Balancing Access with Quality Healthcare: An Assessment of NHIS in Ghana (2004-2008), which was conducted by SEND-Ghana. Data was collected in 50 districts the Upper East, Upper West, Northern and the Greater Accra regions.
As part of the work, the researchers recommend the need for the Ministry of Health (MoH), in collaboration with the Ghana Health Service (GHS) to pay serious attention to the development of existing health facilities, improve upon human resource situation and redistribute health personnel to undeserved and over-burdened communities.
SEND-Ghana is a non-governmental organisation (NGO) with the mission to "work to promote good governance and equality of women and men in Ghana. Its work on the NHIS had the support of the Ministry of Health (MoH), the Ghana Health Service (GHS) and the National Health Insurance Authority (NHIA), among other stakeholders.
The study indicated that the situation of health facilities in some of the regions was even more serious in view of the fact that attendance of patients had increased considerably over the years while the numerical strength of health professionals on the other hand had reduced.
It cited the case of the Northern Region where the number of medical doctors reduced from 32 to 26 between 2006 and 2008 while NHIS membership increased from 281,775 to 828,805.
"In general, more than three quarters of accredited health care facilities (about 76 per cent) covered by this study perceived the NHIS to have negative effect on quality health care delivery", it stated.
In addition, 73 per cent of accredited health facilities indicated that the NHIS affected the quality of medicines health providers prescribed for clients .
To buttress their point, those health facilities cited high market prices of some medicines, delayed claims reimbursement and exclusion of some effective drugs from the medicines list as the reasons.
The report also came out that more than half of the accredited health facilities (about 63 per cent) indicated that the NHIS impacted negatively on attention health professionals provided for clients.
"Out of this number, nearly 79 per cent pointed out that NHIS members spent longer waiting time due to the cumbersome documentation and large patient attendance. The remaining 21 per cent stated that most NHIS clients are not given in-patients attention due to huge attendance coupled with delayed payment arrangement", the report indicated.
The Dean of the School of Public Health, University of Ghana, Professor Fred Binka who reviewed the report said there was the need for the NHIA to know how much money it was receiving each year to enable it to plan accordingly.
He also stated it was important for the NHIA to identify how many people renewed their registration to the scheme after the initial registration and also categorise the registered members according to gender, core poor (indigents), very poor, poor, middle income, rich and the very rich for researchers to know how many members of each of the groups had been covered by the scheme.
In his welcoming address, the Country Director of SEND-Ghana, Mr Samuel Zan Akologo said the research was an independent assessment on the NHIS between 2004 and 2008 and took the opportunity to express his gratitude to all those who helped to make the work a success.
Mr Akologo touched on delays in issuance of identification cards to subscribers, which he pointed out prevented some people who had registered from accessing the facilities.
Statements were made by the Focal Person on NHIS at the MoH, Dr Afisa Zakaria and the Director of Research at the NHIA, Mr O.B Acheampong. The two answered questions from participants and members of the media mostly on the issue of claim reimbursement to service providers.
They indicated that both the MoH and the NHIA were doing everything possible to improve on the NHIS and to also ensure that the scheme was sustained.
The chairperson for the occasion, Dr Sylvia Annie-Akwetey, who is also the Director of Policy Planning at the Ghana AIDS Commission (GAC), expressed the hope that the study could help towards the improvement of the country's health care system to the benefit of Ghanaians, especially people living with HIV (PLHIV).