Fight against illegal payment at NHIS credential healthcare facilities is a collective responsibility

By Godwin AYIKU

In recent times, the National Health Insurance Scheme active members who visit the various credentials NHIS healthcare facilities in the country are met with disappointment.

National Health Insurance Scheme members are requested to pay medical services rendered out of pocket before they exit the healthcare facility. They are forced to pay half of the medical bill or more before their treatment is finalized which is often refers to as Top Ups or Co-payment etc. which is a breach of Nhia-Provider agreement.

This unacceptable practice of illegal payment at the provider sites is creating a lot of discomfort and frustration among NHIS subscribers across the country.

The Ghana National Health Insurance Scheme was established in 2003, Act 2003(Act 650) which was later replaced with National Health Insurance Act, 2012(Act 852) with the sole aim among other policy framework to get rid of the Cash and Carry System in the country.

The main key purpose of the scheme was to provide financial risk protection and reduce the cost of healthcare provision, eliminate all bottlenecks and increase access to healthcare of citizens as enshrine in World Health Organization’s(WHO) Universal health coverage policy document (SDG Target 3.8).

National Health Insurance Act,2012(Act 852) part two No. 32 (3) state that a healthcare provider or health facility to which credentials have been granted shall provide services to member of the scheme only after entering into an agreement with the authority.

The question that arises is, does the agreement between the National Health Insurance Authority and the healthcare providers state that there will be any form of cash payment either part or in full after service delivery? The answer is no, that clause to collect monies from NHIS members is not part of the contract agreement.

The fight against illegal or unauthorized payment at credential healthcare facilities by the National Health Insurance Authority should not be seen as the Authority sole responsibility, but must be seen as a collective responsibility from all its major stakeholders in the health sector especially the Ghana Health Service, the Christian Health Association of Ghana, the Private Health Facilities Association of Ghana and the Ghana Association of Quasi Health Institutions.

The level at which credential healthcare facilities demands unauthorized fees or top ups as refer to from NHIS members who seek healthcare services is unacceptable. All stakeholders must raise to support to end this canker as a united force, Ghana cannot afford to go back to Cash and Carry system.

Key stakeholders in the delivery of quality healthcare as mentioned above must give the needed collaborative support to the National Health Insurance Authority to champion the fight and curb unauthorized fee payment at all the provider sites and desist from paying only lip service in public and collaborate. It seems the fight has been left for the Authority to champion, which is against the principle of achieving universal health coverage and the fundamental human right of citizens which makes sure all people have access to health services they need, when and where they need them, without financial hardship.

Why the Collective or Collaborative Responsibility? National Health Insurance Act,2012(Act 852) part two No. 33 (1) state that the Authority shall in collaboration with healthcare providers and with the approval of the Minister develop a National health insurance scheme medicine list and medicine tariffs derived from the essential medicine list approved by the Minister.

Part two No. 34 (1) also state that the Authority shall in collaboration with healthcare providers and with the approval of the Minister develop a National health insurance scheme service list and service tariffs for use within the scheme and comply same according to part two No. 35(1)

This act of collaboration since the inception of the scheme demonstrates the level transparency and utmost good faith exhibited by the National Health Insurance Authority in its collective decision making, this must be replicated by its stakeholders if there is a national issue of this nature at hand.

Today, under the National Health Insurance Authority, regular and prompt cash flow from claims reimbursement offer numerous benefits to credential medical facilities in terms of their financial stability, operational efficiency and the ability to expand their service and upgrade medical equipment as compared to the previous facility payment model of cash and carry, hence the need for credential healthcare providers and its Mother Associations worked together jointly with the Authority  toward the common goal of eliminating illegal payments(Top Ups).

This phenomenon of illegal payment (Top Ups) which is rampart at the provider sites throughout the country has been a worrying trend for the government and managers of the National Health Insurance Authority.

As witness in the public domain, the National Health Insurance Authority has taken pragmatic steps to curb the widespread of unauthorized charges at healthcare facility sites.

The formation of the Claims and Co-payment Taskforce Committee constituted by the current Executive Management and other public engagements initiated by the hardworking Chief Executive Officer Dr. Victor Asare Bampoe throughout the country is in the right direction even though it has been occasioned under previous Chief Executive Officers of the Authority.

It is public knowledge that healthcare utilization at both Out Patient Department(OPD) and In-Patient Department(IPD) have significantly increased under the National Health Insurance Scheme as compared to the previous Cash and Carry regime in the 1980s, a tremendous transformational transition in the Ghana’s healthcare system.

The 2017 Ghana Living Standard Survey (GLSS 7 Data) studies revealed the above assertion that Ghanaians with health insurance had  significantly higher  healthcare utilization both at Out Patient Department(OPD) and In-Patient Department(IPD)  by approximately 77% higher compared to those without  National Health Insurance Scheme  which invariably can be compared to the previous Cash and Carry regime in Ghana’s healthcare system implemented in 1985, as part of the structural adjustment Programme mandated by the International monetary fund (IMF) and The World Bank.

A sign of relief for public and private medical facilities operators who never experience patient absconding, low patient turnout due to the inability to afford the cost of treatment because of the establishment of the National Health Insurance Scheme in 2003.

Am of the view as Health Insurance Practitioner, regardless of the identifiable  challenges that might occasion itself in the unstable market pricing of medical consumables, drugs, staff remuneration etc. that the Ghana Health Service, the Christian Health Association of Ghana, the Private Health Facilities Association of Ghana and the Ghana Association of Quasi Health Institutions will also take the needed bold steps to support and collaborate with the National Health Insurance Authority to succeed in the fight against illegal and unauthorized payment at all credential healthcare facilities to guarantee public confidence, trust and sustainability of the scheme.

Will the fight against illegal payment end if there is tremendous increase in service tariff and medicine tariff, if credential healthcare facilities and their mother Association’s failed to recognized, support, and collaborate in good faith with the National Health Insurance Authority.

 

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