As part of a gradual, phased, nationwide capitation implementation program, the NHIS capitation payment mechanism will be extended to two more regions by April this year in addition to the Ashanti region.
Chief Executive of the NHIA, Sylvester A. Mensah disclosed the roll-out plan last week Wednesday in Kumasi at a 2-day capitation review meeting with various provider groups.
The Authority had separate engagements with Medical Superintendents of government facilities in the region, the Christian Health Association of Ghana (CHAG) and later met with private providers. Mr Mensah explained that the engagements were necessary to receive critical feedback and suggestions from the groups on the way forward for the policy
He said after the two regions have been rolled onto the capitation system, three others would join by end of September. “And by the end of the year all ten regions of our country should be on the capitation system,” Mr Mensah said.
According to him, the NHIA is about to embark on a massive exercise across the country where all members of the NHIS will select their preferred health facility, which will be responsible for their primary healthcare needs. This selection of primary providers, he said is the first step towards the nation-wide capitation implementation.\
He told the leadership of CHAG and heads of public and private healthcare facilities in the Ashanti region that the NHIA has learnt useful lessons from the pilot and assured them that though many of the challenges encountered have been addressed, the Authority will be careful to apply the lessons learnt from the pilot and recommendations made by the providers as it prepares to extend the system to other parts of the country.
The Capitation program is a government policy intended to complement other provider payment methods currently being used by the NHIA. According to the Health Ministry, by rolling out this payment method for general outpatient care, the NHIA is likely to make the scheme more efficient and prevent abuse of the health insurance system.
The Ministry further reckons that the system will also make providers take better care of their clients or subscribers.
While making a case for the prompt release of funds from government to the NHIA, the providers also called for additional sources of financing for the scheme to enable it meet demands of its rising subscriber base.
The various provider groups suggested that a percentage of the revenue the country makes from the oil sector be allocated to the NHIS to help finance the healthcare provision in the country. According to them, doing this will ensure that every Ghanaian directly benefits from the oil resource. Others also suggested that some revenue from the minerals mining industry be set aside for supporting the provision of healthcare through the NHIS.
The private healthcare providers called for the transfer of the 2.5% National Health Insurance Levy (NHIL) to be made directly into the National Health Insurance Fund and not through the consolidated fund which is the practice currently. According to them, this would help reduce the length of time it takes for funds to reach the NHIS for disbursement to its service providers.
On the phased implementation of the pilot in Ashanti, the healthcare providers were unanimous in their call for some financial compensation from the Authority for inconveniences they suffered in the pilot exercise.
The various provider groups cautioned that adequate education must be done prior to the nation-wide roll-out to avert some of the challenges encountered in Ashanti.
A key recommendation, which ran through all the engagements with the provider groups was the need for the Authority to consider alternative provider payment methods for smaller facilities such as Health centres, CHPS compounds and maternity homes.
The two-day meeting was a follow-up to one held the week before where an independent research consultant presented his findings and recommendations on the experimental phase of the policy. At that meeting, the Ministry of Health increased the capitation rates by an average of 37% after the providers submitted that the rates were low.
According to the NHIA, a final meeting will be held in Accra to fine tune the feedback and suggestions made by the various groups on ways to better package and enhance the capitation policy ahead of the nation-wide roll-out.
Capitation is a provider payment mechanism in which providers in the payment system are paid, typically in advance, a pre-determined fixed rate to provide a defined set of services for each individual enrolled with the provider for a fixed period of time.
The amount paid to the provider is irrespective of whether that person would seek care or not during the designated period. The pilot exercise in Ashanti was intended to generate feedback that would inform the subsequent nation-wide roll-out of the capitation payment method.
The capitation payment mechanism will run side by side the Ghana Diagnosis Related Groupings (G-DRG) method of paying for healthcare.
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