NHIS- The Missing Link!

It is difficult to believe that card bearing citizens under the National Health Insurance Scheme are being turned away from some public health delivery facilities especially in the Volta Regional capital, Ho if the newspaper publication of the Ghanaian Times, Thursday September 3, 2009 is anything factual. Equally disturbing is news that there is a selective treatment of patients under the National Health Insurance scheme citing unpaid claims by the Health Insurance Authority, over the past 12 months, resulting in the inability of the facilities involved to deny beneficiaries free medical care.

Upon checks from the CEO of the National Health Insurance authority, he admitted that the system as bequeathed to him by the out gone CEO Mr. Ras Boateng under the Kufour-led administration owed Health delivery facilities a total of 115 million Ghana Cedis, which his outfit paid only 2 weeks ago, hampered smooth management of the scheme. Mr. Sylvester Mensah, CEO of the NHIA, confirmed that he has paid visits to some hospitals in the Volta and Eastern Regions to ascertain developments resulting from these challenges. At least for once we are seeing clear signs of transparency and truthfulness as regards the state of the NHIS under his leadership, as to how the out gone CEO and his officials should sit down to allow the scheme to allow the scheme to accumulate so much debt to this tune should be a matter for forensic investigations due to the critical role public health delivery plays in the daily life of the Ghanaian.

Leading to the December General elections, the NPP promised doom to the National Health Insurance scheme under an NDC led administration if the good professor was voted into office. The National Youth Employment programme was also not spared this vile propaganda. Eight months into the Mills administration facts and figures indicate that government has rather made expansionary moves into the above mentioned programmes albeit the current challenges that bedevils these schemes, chief among which is the current debt burden of the National Health Insurance Authority.

A setback to the National Health Insurance Scheme is the hydra headed bureaucratic bottlenecks inherent in its centralized system. From the operators of the scheme, it takes approximately two (2) months for the clinics and Hospitals rendering the service to submit their claims to the Authority. It takes time for the submitted claims to be verified and after this verification, it takes another four (4) weeks for the National Health Insurance Authority to pay the verified claims to the local clinics and hospitals. It therefore takes at least five (5) months for payments to be made from the operators of the scheme to the beneficiaries, while it is expected that hospital administrators keep servicing their clients on credit till the claims are paid in the middle of the year. I wonder which public or private health institution could keep rendering credited services to the public for such a time while awaiting their receipts from the authority. This development is unacceptable and the CEO of the scheme must initiate moves to address this phenomenon.

There are clear cases of corruption in the system where some Health administrators submit false or double claims in a bid to milk the Authority. This crime occurred in some health facilities in the Ashanti region as reported on the front page of the daily Graphic sometime last month. This revelation exposed the covert activities by saboteurs of the scheme since its inception and I wonder why it had to take a change of government to bring the perpetrators of these criminal acts to justice. The media should follow this case closely to ensure that those found culpable are not spared in the criminal justice process to deter others who might have already nurtured this diabolic idea to sabotage the scheme.

As of today, the NHIS does not cover some salient ailments that are common in Ghana. Worst still is the limited prescribed drugs that are covered by the scheme. It is therefore a daily affair that patients under the NHIS go to the Hospital and pay cash for laboratory tests, drugs and other services rendered by those clinics. The end result is that patients are turned away on daily basis if they do not have cash in hand to pay and these services and therefore feeds into the wrong assertion that the government of the day is responsible for these inadequacies. Under the scheme, some pharmacies are supposed to provide free dispensary services to the public but this is yet to be known let alone practiced in our communities. The bad public relations outfit of the NHIS ought to rise up to the call. The outfit neglected their core duties of informing the public on the services the scheme renders but rather concentrated on engaging in undue politicking before the 2009 general elections with clear intentions to win favour for the NPP candidate. I urge the Chief Executive Officer of the National Health Insurance Scheme to reorganize the Public Relations outfit of the Authority as early as possible in tune with the vision of the new board and the Better Ghana Agenda.

The limited coverage of the scheme to the various districts is worth mentioning. It is a fact that one can only access a health facility if only one is within the boundaries of the district of registration. One is doomed to pay for consultancy if one finds oneself in another district in the same region and worse still in another region in Ghana.

In offering a better public health delivery service to the expectant public in Ghana, these challenges must be addressed.

Foremost, once the 115 million Ghana Cedis debt Mr. Ras Boateng et al saddled the Scheme with has been paid by the new administration, there should be immediate arrangements to reduce the time frame between submission of claims, verification and payments to the barest minimum. This arrangement will ensure that within any given time, funds are made available in the clinics, hospitals and service centers to support the scheme. This of course calls for some mechanization and a complete overhaul of the operations of the Scheme to which the Mr. Sylvester Mensah should rise to. In these days that almost every aspect of the nation’s economy is mechanized and computerized, the NHIS has no excuse not to automate their operations. The automation of the system should be decentralized to all Regions and Districts so that claims could be paid from the Regional Administrators of the Health Insurance Authority to eliminate the over concentration of all administrative functions of the scheme to Accra. I must admit that this might be the long term solution to the problem and of course it demands good broadband penetration and logistical support coupled with in depth IT training for hospital staff and administrators who will handle the project. Second, it is important to create a buffer fund at the District Assembly level as a stop-gap measure to limit the long period between submission and payment of claims right away. This buffer fund should be curved out of the District Assembly Common Fund and other internally generated funds and managed by a qualified Accountant and a representative from the National Health Insurance Authority. The purpose of this fund is to reimburse a percentage (50% percent at least) of claims submitted by facilities within the District within a certain period of time as the District waits for the processing of the claims as submitted by the health service providers. This will ensure that there are at least some funds available at all times in the district from which the local clinics can draw from upon an initial verification in order to eliminate the embarrassment of the long payment period by both the National Health Insurance Authority and the service providers. As and when the verified claims are released from the national headquarters of the NHIA to the Districts, the differences are then paid to the clinics and Hospitals.

Third, with alacrity, those who have already been found culpable in submitting double claims from their Clinics and Hospitals should be prosecuted and punished as a deterrent to others who intend to milk the state dry out of their insatiable greed.

Four, another look should be taken at the services, drugs and ailments currently covered under the scheme in consonance with the Mills administration’s commitment to expand the scheme and make it more beneficial to all and sundry and to give true meaning to the “free” component of the scheme.

Five, to check the case of corruption in the system, random checks, visits by scouts from the National, Regional and District offices should be paid in the health delivery facilities for monitoring purposes. Immediate action should be taken to reorganize and reorient the public relations outfit of the NHIA with a possible introduction of a complaints department to deal directly with problems patients face in the clinics spontaneously.

As Ghana awaits the implementation of the one-time premium payment under the Public health Insurance, these efforts must be made to improve the existing system.

God bless our Homeland Ghana!

Felix Mawulolo Amegashie

elolo.elolo@gmail.com