Ghana’s National Health Insurance authority is taking health care providers for a ride

Health Insurance is a type of Insurance coverage that pays for medical, surgical and sometimes dental expenses incurred by the insured. Health Insurance can also reimburse the insured for expenses incurred from illness or injury, or pay the health care provider directly.

It is often included in employer benefit packages as a means of enticing quality employees. And in some instances, premiums are partially covered by the employer, but also often deducted from employee paychecks.

The cost of Health Insurance Premiums is deductible to the payer and the benefits received are tax-free (Source: Julia Kagan, 2019). Ghana has one of the best Health Insurance covers for its citizens, as her population is dominated by people in the informal sector finding it difficult to afford Quality Health Care.

The Health Insurance cover in Ghana is backed by a Legislative Instrument through an Act of Parliament. Premiums are mostly paid off by the Ghana National Health Insurance Authority after health care providers submit claims, and the authority mandated by law process the insurance claims through vigorous audit before providers are paid.

National Health Insurance Act 2012, Act 852, mandates the agency to consolidate the NHIS, remove administrative bottlenecks, introduce transparency, reduce opportunities for corruption and gaming of the system, and make for more effective governance of the schemes. That's the ACT that establishes the NHIA, replacing the old ACT, 2003, ACT 650. One of the various functions of the NHIA is to receive, process and pay claims for services rendered by healthcare providers.

Over the years the NHIA has received processed insurance claims from its healthcare providers without adequately reimbursing them. Healthcare institutions need drugs, consumables and non-consumables to run effectively. They have the extra responsibility of having to service their utility bills including electricity, water, telecommunication, internet data for administrative work, and running of softwares such as oasis and HAMS.

Some institutions have a daunting task of raising money to purchase fuel for transporting managers, administrative and support staff, and carting of supplies to keep the facilities running 24/7; whilst others rely solely on their 2% Internally Generated Fund to pay those on their payroll (casuals) and their employees.

So at the end of the day, there is apparently nothing left to keep the facilities running and providing quality healthcare to it numerous clients. Hence, the propensity for some of these facilities to collapse and run out of business is really high as they are always owing suppliers for consumable, and can only pay as and when the NHIA makes partial reimbursement.

At a time the world is battling the dreaded COVID-19 pandemic, facilities have to be adequately prepared to purchase more Personal Protective Equipments (PPE) for their Healthcare staff. As at now, there is inadequate or virtually non-existent funds in their coffers to help in purchasing these items. How are our health professionals expected to protect themselves as they go about discharging their duties?

The body mandated by law to ensure there is regular and timely payment of claims to Health Care providers have now all of a sudden become a philanthropic agency; donating huge sums of money to the COVID-19 fund. You cannot be a citizen when things are not done right. How on earth could they donate GH¢250,000 when health care providers lack PPEs, most are struggling, and others collapsing owing to their indebtedness to such facilities?

What kind of country are we living in? Was the donation done because others were donating? Why has the constitutionally mandated NHIA run away from its core responsibilities of paying money's owed to its healthcare providers? Aren't we joking in this country?

Aaron Mensah

A public Health Officer

Email: Aaronny23@gmail.com