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Health News of Thursday, 12 January 2012

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Capitation of the NHIS in the Ashanti Region


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Capitation Of The National Health Insurance Scheme In The Ashanti Region; The Views Of The Ashanti Development Union (ADU)



12/01/2012



ADU is much concerned about the implementation of the pilot capitation of the NHIA in the Ashanti region. ADU considers the present state of implementation of the capitation unacceptable and must be rejected at once. The NHIA is being insensitive to the Ghanaian who pays 2.5% NHIS levy of the Value Added Tax towards his or her health. We believe, with the levy, the scheme could even expand the existing service instead of the capitation proposed. The group is also disappointed in the Ashanti Parliamentary Caucus for agreeing to the pre-testing of the Capitation which has created a lot of discomfort to our people. ADU will not sit down unconcerned whiles this uncomfortable situation continues in the region. What is the meaning of capitation to the normal Ghanaian especially the people in this region? Have the providers understood the terms and the conditions governing this policy? Our concern about the capitation stems from the following;



a. What could be the principal reason for the inception of the capitation?



b. If the objective is to curb the leakages in the existing National Health Insurance Scheme, then better modes should have been developed other than the capitation presented.



c. Is the 2.5% of the NHIS levy on the Value Added Tax not enough to take care of Ghanaians?



ADU believes that the idea of capitation is seriously flawed due to the following reasons:



1. The amount suggested for the capitation i.e. payment per person per month of GHC 1.45 for government facilities and GHC 1.75 for private facilities is woefully inadequate and will go a long way to undermine the provision of health care with irreparable damage on the health of the people in the region.



2. Of the amount suggested above GHC 1.11 is for services rendered and GHp 0.65 for medicine for enrolled clients in the region. One therefore wonders what kind of medication could be obtained with such a scanty amount. The NHIA used to compensate clients with about GHC 12.00 for private hospitals.



3. From 1 and 2 above, the capitation can only promote shoddy health service delivery



4. The mode of implementation of the capitation leaves much to be desired. For instance awareness by subscribers to register is very low. Again, there is no feedback mechanism as to where a person is placed out of the three choices. If such a person falls sick, where is he to go?



5. The idea of paying an equal sum per person for both the sick and the healthy under the capitation is rather infantile. This is because nothing binds the care providers to supplement the GHC 1.45/1.75 with that of those who did not report sick. Indeed amounts budgeted for registered members who did not report sick shall accrue to the care provider without any means of accounting for.



6. The capitation amount is supposed to be per month, is it realistic for someone who falls sick more than once in a month to access health care based on such peanuts?



7. The capitation provides for a set of prescribed drugs that must be administered. It means that there is a restricted scope of drugs under capitation. This is improper because people react to different drugs differently; therefore what might be good for one patient might not be for the other, the capitation should never have outlined a set of prescribed drugs to be administered.



8. The absence of the Private Medical and Dental Practitioners in the implementation of the pilot capitation seriously undermines the scheme and renders it ineffectual. The CEO’s comment concerning the private providers is unfortunate. He needs to retract or resign because he does not understand health system in Ghana.



Based on the above ADU is of the opinion that the idea of capitation lacks substance and must therefore be rejected outright. It is hereby resolved that: 1. The NHIA has observed enough from the implementation so far to notice that the capitation is not prudent, and should bring it to an end. 2. ADU is ready to hit the streets if the NHIA does not immediately put an end to the pilot policy in the region.



CC : the Regional Minister Regional House of Chiefs Ashanti Parliamentary Caucus Long Live Ghana!!!



COORDINATOR ................................... Edmond Oppong-Peprah (0244247799)

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