Others Treated For Fibroid & Cervical Cancer

Managers of the National Health Insurance Scheme (NHIS) have justified and given evidence to show why they chose no other region than the Ashanti Region to test the feasibility of its capitation programme.

The arrangement which was protested by health officials in that region, led by none other than the Ghana Medical Association (GMA) President, Dr. Kwabena Opoku-Adusei, was to eliminate fraud, abuse and leakages in the system with respect to claims.

There were instances where treatment of female only ailments such as cervical cancer, breast cancer and fibroid were said to have been carried out on males during the vetting of the claims made by some hospitals in the Ashanti Region.

In other instances medicines received by patients were totally different from what they should have been given for their ailments. Men were recorded as having given births and in some instances under Caesarean Sections.

For this reason, the capitation programme was made as a payment system under which accredited health care providers were to receive advance payment at a pre-determined fixed rate, to provide defined package of services to each subscriber.

Twenty-seven districts in the Ashanti Region were selected by the Authority to pilot the capitation programme, which was expected to take-off throughout the country last July, but due to protests by health service providers, the programme had to be suspended indefinitely.

Chief Executive Officer (CEO) of the Authority, Sylvester Mensah, in a media encounter last Monday, in Accra, made these known.

Mr. Mensah who showed diagrams including graphs and pictures from across the country, demonstrated that the Ashanti Region led in claims collection from the Authority for services rendered to patients by the providers, and these claims exceeded the actual number of people who had registered for the scheme in the Ashanti Region.

This means that the amount of money that were demanded by providers for having treated patients with various diseases of the scheme outweighed the total number of people who at the time had registered in the region.

For instance, Ashanti Region alone in 2011, according to the chart, revealed a total of 30.4% claims as against a membership of 21.9%, a situation which existed only in that region.

In the run-up to the December 7 elections, the New Patriotic Party (NPP) flagbearer, Nana Addo Dankwa Akufo- Addo, has led campaign against managers of the scheme, accusing them of incompetence and misappropriation of funds, leading to the collapse of the scheme.

Though the Authority through press statement and statements have warned politicians more importantly the NPP from politicizing the scheme as it doing far better than they came to meet in 2009.

Mr. Mensah was emphatic that Mr. Akufo-Addo should stop denigrating the scheme in his nationwide campaign tours, by playing politics with the programme.

Not even statistics from the NHIS could make the NPP rescind its attack on the scheme as was captured last Wednesday in a presentation themed: “saving our health service, keeping our people healthy,” at the Sunyani Nurses Training College. The NPP flagbearer accused the NDC government of creating so much instability in the scheme, leading to a public wane of confidence in it.

According to him, there was a “decline in membership in the NHIS and a corresponding increase in visits to the hospital by NHIS cardholders and cited the Authority’s own annual reports which indicate that active membership dropped from 9,914,256 at the end of December, 2008, to 8,204,116 by the end of 2011”.

He said the scheme in 2008 had the capacity to lend to banks, but it is the reverse now position.

“In 2008, under the NPP, the NHIS was a net lender to Ghanaian banks. Now, it is a net borrower; and as at December 31, 2011, the scheme owed the banks GH¢105 million,” he said.

But in sharp rebuttal, Mr. Mensah on Radio Gold yesterday debunked Nana Addo’s claim, saying he lacked the basic understanding of the operations of the scheme, and wondered how a person who was seeking to lead this country could have such a deficiency.

He said the scheme was not indebted to any bank as was being claimed by Nana Addo, and challenged him and others including ex-CEO of the NHIA, Ras Boateng, to a debate, saying Nana Addo’s comments betrayed how little he knew about the National Health Insurance Scheme.

He further described as “pathetic” Nana Akufo-Addo’s campaign promise of free healthcare for all under 18 if elected President.

“It is so pathetic, I mean you don’t understand what pertains and yet you are describing what you want to do. On what condition is he building his vision” Mr. Mensah querried.