Resolving The Crisis of Health Care

A GNA Feature by REX ANNAN
Accra, May 20, GNA - Globalization, which is wheeled by ICT and driven by the International Monetary Fund (IMF) has eased information flow and acquisition of funds. The issue now is the operation of ICT and management of the solicited funds.
To this end, most countries have placed premium on the human resource training and the health needs of their citizens to make them meet the global technological advancement.
Ghana in recognition of this has provided the type of education that would make the graduates think "straight" and also introduced the National Health Insurance Scheme (NHIS) to meet the health needs of the masses.
Most Ghanaians, through intensive public education have bought in to the Health Insurance policy with the result that 65 per cent of the citizenry have been covered by NHIS as at December 2008.
The Health Insurance Scheme has occasioned significant increases in attendance at the out patients departments at the various health facilities, nationwide.
The health status of the masses has invariably improved as most people have adopted prophylaxis/preventive measure as a way of staying healthy as against the curative approach of staying healthy under the previous "Cash and Carry" system as they quickly report to the hospital any symptoms of ill-health.
The Health Insurance, notwithstanding its numerous benefits is currently in management crisis, for non-payment of claims submitted to the National Secretariat of the Scheme.
As at May 2009, the health insurance authority had enough money at the national level. The money was enough to pay for all claims submitted for the next three and half years, even if they did not get any funding for the same period.
It is therefore difficult to comprehend why there is so much complaint from health care providers to the various local schemes for non-payment of outstanding claims for six months.
The ironies are that the Authority at the national level gives the local scheme a specific amount of money to manage for a quarter of the year. Unfortunately what is released does not meet even half of the claims submitted for the same period.
The situation fell into a tailspin in 2008 due to the tripling in claims submitted by health care providers as a result of the authority changing from "pay for service" to the current "diagnostic related grouping" in practice now.
This was worsened by the introduction of free delivery services to pregnant women for which there has been no payment for such services since its inception.
There is therefore a yawning gap between monies given to the schemes and claims submitted.
Additionally, the health insurance drug price list has not been reviewed and there are two effects as a result of non review.
Currently, there are a number of drugs on the health insurance price list, which the cost price is now higher than that on the list as shown by the table below.
LIST OF MEDICINES WITH COST PRICES HIGHER THAT OR EQUAL TO NHIS PRICES
GENERIC NAME, DOSAGE FORM, STRENGTH
COST PRICE NHIS
Cholera replacement Fluid 5:4:1 1.2/500ml 1.25/500ml
Dextrose infusion 5% 1.05/500ml 1.05/500ml
Diazepam inj 5mg/ml in 2ml 0.23/amp 0.15/amp
Hyoscine Buty Bromide inj 20mg/ml 0.28/amp 0.25/amp
Insulin premixed (30/70) HM, 100units/ml in 10ml 19.5/vial 17.55/vial
Insulin Soluble HM 100units/ml in 10ml 19.5/vial 18.10/vial
Ergometrine inj 0.5mg/ml 0.28/amp 0.25/amp
Gentamichin inj 40mg/ml in 20ml 0.1/vial 0..05/vial
Lidocaine inj 2% in 20ml 1.00/vial 0.76/vial
Nifedipine cap 10mg (slow release) 0.226/cap 0.15/cap
Praziquantel tab 600mg 0.299/tab 0.02/tab
The other scenario is that there is another group of drugs whose price at cost is now very near to the price list.

Another disturbing issue is that the health insurance authority introduced an operationalized ICT platform in 2008 to improve flow of information from the local level to the national level.

The concept is excellent but the Authority acquired a broadband, which has a low speed and incapable of transmitting efficiently information sent by all the schemes to the national level. The scheme platform is used to transmit both claims entries and data entry, which simply put is the sending of information to the national level of those who want health insurance cards and have paid the required premium.

Difficulty in sending such data has led to the inability of the schemes to fulfill their promise of getting any person who pays the premium a card within three months since the cards are all produced at the Headquarters in Accra and its readiness for use is dependent on when the transmitted information gets to Accra.

Owing to the low speed of the broadband, there is a backlog of client data at all the scheme levels.

The way forward is to match minimally money sent to the scheme to the claims submitted by the health care providers.

This will ensure that there would be about two months' outstanding claims to be settled as against the current state of six months. The move would to a large extent cushion care providers, who are complaining because they are no longer credit worthy and the suppliers are on their necks daily, putting on them unbearable stress.

There is also an urgent need to review the health insurance price list as there is no motivation to supply drugs whose cost price is higher than that of the price the suppliers will be paid for.

On the issue of the low speed of the broadband, the prescription is to secure a broadband, which has the ultimate speed to enable speedy transmission of information from the schemes level to the national level.

The game of shifting of blame must be stopped; and no staff at the scheme end should be blamed for what is originating at the national level.

Ways should be found to reduce fraud within the system. One wishes to welcome the Health Minister to the challenge of providing sustainable and effective health care to the citizenry.