Health News of Monday, 23 June 2014
The National Health Insurance Scheme (NHIS), introduced 10 years ago, presents a promising future for many people, particularly those in the rural areas who cannot afford quality health care.
Following this, there are a number of non-governmental organisations (NGOs) presently working in remote villages and towns in the Volta Region trying to register deprived persons with the scheme.
In a small village called Adzorvi in the Agotime-Ziope district, a number of inhabitants are undergoing registration by the National Service Secretariat (NSS) working together with the National Service Personnel Association. About 150 people have so far been registered. They are mainly the aged and children.
According to the District Director for the NSS, Mr Josiah Lomotey, the registration exercise was a social responsibility effort on the part of the secretariat. He said the objective was to assist the people who mainly relied on herbal medicine for cure to their ailments due to financial constraints.
Besides the benevolent registration of people in the area, programmes put in place by the NHIS, including promotions and community entry programmes, have also helped to increase membership in the region.
According to figures released by the National Health Insurance Authority (NHIA) in the Volta Region, out of a population of 2,287,710 inhabitants in the district, about 985,453 have been registered with the NHIS.
Observation at some hospitals
In an interview with some subscribers of the NHIS in some hospitals, many of them were unhappy about the long hours they spent at the hospitals to receive medical care. A number of the people felt discriminated against in favour of persons who were outside of the scheme.
They alleged that health workers rather preferred the ‘cash and carry’ system as they got paid instantly for their services.
A lady by name Mamavi, who had brought her 10-year-old son to the Ho Municipal Hospital under insurance cover, said she had been waiting for hours without her son receiving any attention.
According to her, even though the process looked burdensome, she was ready to wait her turn because she did not have enough money to pay the huge cost involved with cash and carry despite the fact that it was quicker.
Meanwhile, health officials in the region have explained that health delivery processes at hospitals were not discriminatory as alleged. The delay in attending to patients was simply because of the large numbers of people who sought for medical care.
In addition, the authorities contend that they have to go through a number of processes to ensure that patients are truly subscribers to the scheme before attending to them
Health providers paid
One major challenge facing smooth implementation of the NHIS has been the delay in payment of claims to health service providers by the regulatory body. As a result, some health facilities in recent times are reported to be pulling out of the scheme because delays in reimbursing them were affecting their operations.
Fortunately, the Volta Region is not yet beset with such a problem. Despite that some health establishments have not been paid their claims for the past five months, there are no threats to pull out of the scheme.
The delays in payment of claims, according to the Volta Regional Director of NHIA, Mr Elliot Nestor Akototse, were not caused solely by the authority. He said some health service providers put in their claims very late.
He said at present, all health institutions in the region had been paid their claims for last year, while the work was ongoing to pay for January and February this year.
High cost of drugs
There have been many reports in the Volta Region about the high cost of drugs. The situation has worsened as subscribers are made to pay extra amounts to cover the cost of prescribed drugs at the pharmacies.
The pharmacies explained that the high cost of drugs was because the cost of medicines on the market had gone up without corresponding increases by the NHIA which was still using the old price list. They said in order for them not to become indebted to their creditors, patients under the cover of the NHIS were required to top up with an additional amount before they got their medicines.
According to Mr Akototse, the difference in the cost of drugs as was being demanded by the pharmacists would soon be resolved following the release of a new drugs list.
Capitation process ongoing
The Volta Region is one of the three regions earmarked for the second phase implementation of the capitation scheme.
The performance of the scheme in the region generally has been encouraging, but there is still room for improvement. The expectation is that there should be marked improvement when the capitation scheme comes on board.
What is capitation?
Capitation is defined as a payment system that allows service providers to be paid in advance a predetermined fixed rate at which services are provided for a given period.
It is considered a win-win reimbursement policy that has a lot of benefits for subscribers, providers and the scheme as a whole.
The implementation of capitation is expected to encourage competition among health service providers because subscribers have the option to change service providers if they are not satisfied with the services they are receiving. It is also expected to foster better relationships between doctors and patients.
Stress in obtaining cards
There is also the problem of delay in the issuance of NHIS cards. Presently, it takes months for a registered subscriber to receive his or her card. This phenomenon is discouraging others from joining the scheme.
There are often long queues at the registration centres because the registration process is slow. Many have expressed their desire to have the period for registration extended to the weekends.
The biometric registration system will be introduced in the region by November this year. It is expected to ease the stress people have had to endure before receiving their cards.
Meanwhile, there is a system in place that allows pregnant women to receive their registration cards instantly. It is hoped that this will encourage pregnant women to readily register with the scheme.
Notwithstanding the challenges that the NHIS is confronted with, it has come as a relief compared with the discomfort one had to undergo with the ‘cash and carry’ system which was also selectively affordable to the rich. With the NHIS, even the poor are covered and can seek qualitative health care.