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The Upper East Regional Director of the National Health Insurance Scheme ( NHIS), Mr Sebastian Alagpulinsa, has observed that the Implementation of the Biometric and the Capitation concept of the Scheme were key to its sustainability.

The Regional Director, who made the observation during a stakeholders’ forum held at Bawku in the Upper East Region, said the NHIS was one the most efficient means of social protection established by the government to help address the health needs of Ghanaians particularly the vulnerable.

He expressed regret that despite the good intention of the scheme, if stringent measures were not taken to address the way and manner the scheme was being abused and defrauded by some health service providers and clients it could lead to its collapse.

He cited for instance the illegal practice of recycling and double billing by some health service providers and some clients who often sought medical attention at more than one health facility with the same complaint or use their cards to collect the same medicines at different health facilities.

He mentioned that to help address the problem and ensure efficiency and sustainability of the Scheme, the NHIS had started the issuance of Biometric Membership cards and the implementation of the Capitation scheme.

Mr Alagpulinsa stated that apart from the biometric membership cards reducing frustration, duplication of records and fraud, the instant issuance of the cards to the clients would also help boost the confidence of the client.

“It will also help check the moral hazards of claims recycling and double billing by some health service providers, which is currently a threat to the financial sustainability of the scheme in the country,” he stressed.

He said the biometric system would also serve as a check on the duplication of membership data which would help enhance the credibility and integrity of the scheme as well as help promote effective planning to ensure that resources were efficiently and effectively put into good use.

He stated that the Biometric system would also provide an avenue for subscribers’ authentication at the provider site and facilitate the generation of claims code for processing of claims by providers for payment.

On Capitation, he explained that it predetermines fixed fees paid in advance to health service providers at a fixed period of time for a defined set of services for clients.

“The method has been tried and tested across nations and has proven to be an effective cost containment measure and therefore a panacea for financial sustainability of the scheme”

Mr David Samari, the Coordinating Director of the Bawku Municipal, mentioned the simplification of claim vetting and processing, cost containment, sharing financial risk, improve efficiency and effectiveness, foster closer provider-patients relationship and correction of imbalances as some of the benefits of the capitation concept.

He explained that under the capitation concept clients are given the choice to choose their preferred medical facility and may decide to change the facility if they are not satisfied with the services of the health service providers.

The stakeholders’ forum under the theme, “Introduction of Biometric Membership Solutions and Capitation to enhance efficiency and sustainability of the NHIS”, attracted traditional authorities, political leaders, health staff, district assemblies, service providers, clients, among others from the Bawku Municipal, Binduri and Pusiga Districts.