Matters arising in health insurance implementation in Ashanti

The National Health Insurance Authority (NHIA) has activated a Claims Processing Centre (CPC) in the Ashanti region to ease delays in vetting claims for re-imbursement submitted by health service providers.

The Authority has also introduced the e-claims service, an electronic payment system, to reduce the length of time for receipt of payment by providers.

Some health service providers in the region have not been enthused with the delayed payment of claims. Administrator of the Brodekwamo Methodist Clinic, Kwasi Odame, says delayed payment and mounting arrears in health insurance claims is one of the major challenges hampering service delivery.

“It is an institution that gets support from the government, so at the end of the day we request for funds and if the funds do not come in early, it will delay the payment,” acknowledged Bawa Nurudeen, Ashanti Regional Manager of the NHIA.

He is however optimistic the claims processing centre will be one of the interventions to address the challenge in vetting of claims.

“With effect from 1^st December 2013, all providers who are under the sub-metro schemes – Asokwa, Subin, Manhyia, Bantama and Ejisu – are supposed to submit claims to the CPC. It will speed up the turnaround time with which we use to process claims and also ensure prompt payment,” stated Mr. Nurudeen.

He has also debunked assertions that the implementation of the health capitation is responsible for increase in maternal and infant mortality in the region.

“Everything about maternal services is not part of capitation, and so if a pregnant woman goes to a facility and the facility fails to provide certain medication – remember the medication is also paid for by the health insurance – capitation has nothing to do with drugs and so if drugs are not dispensed, we should not blame capitation,” he stressed.

There are presently over 400 health facilities under the health capitation in Ashanti. Some of these facilities and other interest groups have expressed disapproval in the pilot implementation of the scheme in Ashanti since it was introduced in January 2012.

Meanwhile, the Health Insurance Providers Association of Ghana (HISPAG) has opined that delinking the National Health Insurance Authority from government control would improve efficiency in service delivery.

Frank Richard Togblo, Chief Executive of HISPAG believes such autonomy would protect the health scheme from political manipulation “so that it will not be an issue that tomorrow when another government comes, he changes the direction and focus of the NHIA.”  

“Once it is established by law, there is nothing that can change it, unless they have to go back to parliament to scrap it off. Just as we have SSNIT and Ghana Revenue Authority, which are completely delinked from the government, so it should be as far as the NHIA is concerned,” he asserted.

Story by Kofi Adu Domfeh