On the 14th of June, 2012, an interview granted by the Chief Executive of the National Health Insurance Authority, Mr Sylvester Mensah, was aired as part of the mid-day news on Ghana’s TV3.
In the interview, Mr Mensah clarified issues about the National Health Insurance Scheme (NHIS), particularly, pertinent issues such as the proposed One-Time Premium, (a once in a lifetime health insurance premium) and Capitation, an additional provider payment mechanism currently being piloted in the Ashanti region of Ghana.
Subsequently, a mischievously twisted and distorted version of the news item, authored by one Yaw PK Manu, was posted on Ghanaweb under the misleading caption “NHIS is Dying – Mensah”.
The statements attributed to the Chief Executive on Ghanaweb have been deliberately falsified for effect.
This was calculated to mislead readers and also to misinform them about what he actually said in the TV3 news interview.
• The Chief Executive never said that the “NHIS is dying”.
• The Chief Executive did not say that Maternal Care and Medicines have been withdrawn from the scheme
• The Chief Executive did not say that plans are far advanced to significantly increase NHIS premium rates from January 2013.
• The Chief Executive did not say that with a current annual expenditure of GHC19 million the scheme is struggling to stay above waters.
What the Chief Executive actually said was heard clearly by viewers of the TV3 mid-day news. We would like to set the records straight on the twisted and distorted version of the news item.
MATERNAL CARE & MEDICINES ON THE NHIS:
Contrary to Yaw Manu’s false claims, medicines are still in the NHIS benefit package and have not been withdrawn. Maternal care services are still free on the NHIS. The statement attributed to the CEO, that Free Maternal Care and Medicines have been withdrawn from the scheme therefore is absolutely false. Maternal care services are still free of charge for mothers, and are being paid for by the NHIA/NHIS. Infact this service has been enhanced. Today, even the test to confirm pregnancy is covered.
The Chief Executive, Mr Sylvester Mensah did mention that Maternal care (ante-natal, post-natal and deliveries) and Medicines had been taken out of the CAPITATION BASKET of services as a concession to healthcare providers.
This was in reference to the capitation pilot in the Ashanti Region in response to concerns and requests expressed by healthcare providers.
When capitation was introduced in the Ashanti Region, service providers in the region suggested that the NHIA pay for free maternal care through an existing payment mechanism called G-DRG, instead providers using capitation money to cover such services. The NHIS agreed to do so. They also argued that if they have to use the capitated amount to cover medicines they will have difficulties.
Therefore, as a concession, the NHIS agreed to pay for medicines separately through the existing itemised billing, rather than from the capitation money that providers are paid in advance. Medicines therefore continue to be prescribed and dispensed as before and paid for by the NHIA/NHIS.
This means more money in the kitty for providers to take care of NHIS patients under capitation. Currently the NHIS medicine’s list has been reviewed to include other new and efficacious medicines, bringing the number of medicines under the NHIS medicines list to 550.
Apart from these gestures, the NHIA also increased the money paid in advance to healthcare providers under capitation. This also means yet more money in the kitty for providers to take care of NHIS patients under capitation.
UTILIZATION OF HEALTHCARE SERVICES:
The Chief Executive did not say that the current annual expenditure of the scheme is about 19 million Ghana Cedis. What the Chief Executive said, and which was clear in the TV3 mid-day news was that utilization is not less than 19 million.
Utilization represents medical encounters or visits by patients. Utilization is measured by number of visits, not money. It is therefore unfortunate that the stated utilization figure has been monetized and wrongly presented by the writer as annual expenditure.
Furthermore, the Chief Executive did not say that plans are far advanced to significantly increase NHIS premium rates from January 2013.
REFORMS & IMPROVEMENTS IN THE NHIS:
Far from being moribund, the NHIS is undergoing reforms that are driving efficiency and productivity.
Notable amongst these are the introduction of a Claims Processing Centre which has significantly improved claims processing and reduced delays in claims payments to providers, and the introduction of Clinical Audit to eliminate abuse and improve quality of care, not forgetting the mass registration exercises that are expanding health insurance coverage of the poor and vulnerable. Key stakeholders attest to the improvements in the NHIS.
The NHIS remains the financial mainstay of the numerous accredited healthcare service providers in the country. It is a source of funding for the procurement of a significant amount of medicines, medical consumables, services, capital projects, logistics and vital equipment for service providers. It accounts for more than 80% of internally generated funds in public health facilities.
Furthermore, study tours by an increasing number of visiting foreign delegations affirm the rising profile of Ghana’s NHIS as an emerging model for countries in the Developing World and beyond. It would be recalled that in November 2010 Ghana’s NHIS proudly won the UN award for excellence in such categories as, leadership, home grown initiatives, innovation, scalability of strategies, efficiency and as a hub of shared learning and shared experience in the developing world and beyond.
These significant strides are signs of vitality and rude health of the NHIS.
It would be prudent not to politicize the NHIS and undermine public confidence in a national institution that all Ghanaians should cherish and support; a healthcare safety net for the poor and vulnerable, acclaimed globally for its worth and rising profile as a model for other countries.
Issued by Strategy & Corporate Affairs Directorate
National Health Insurance Authority
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