On the 15th 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 on the internet 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• The Chief Executive did not say that Maternal Care and Medicines have been withdrawn from the scheme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 that appeared on Ghanaweb.
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Contrary to Yaw Manu’s false claims, medicines are still in the NHIS benefit package and have not been withdrawn.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. 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 is reference to the capitation pilot in the Ashanti Region in response to concerns and requests expressed by healthcare providers.
When capitation was being introduced in the Ashanti Region, service providers in the region suggested that the scheme pays for free maternal care through an existing payment mechanism called G-DRG, instead of capitation. The NHIS agreed to do so. They also argued that if they have to use the capitated amount to cover medicines it will not be enough. Therefore, as a concession, the NHIS agreed to pay for medicines separately through the existing itemised billing, different from the capitation money that providers are paid in advance.
Medicines continue to be prescribed and dispensed as before and paid for by the NHIA/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 directly under the existing payment method called DRG. Healthcare providers do not use the capitation money advanced to them to cover such services, meaning more money in the kitty for providers to take care of NHIS patients under capitation.
Again, contrary to Yaw Manu’s false claims, medicines are still in the NHIS benefit package and have not been withdrawn. The Chief Executive’s statement means that healthcare providers do not use the capitation money advanced to them to cover medicines. Medicines continue to be prescribed and dispensed as before and paid for by the NHIA/NHIS. This also means yet 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.
It is worth remembering that under capitation healthcare providers are paid in advance a pre-determined amount of money to take care of NHIS patients who have chosen them as their Preferred Primary-care Provider (PPP).
Utilization of Healthcare services:
The Chief Executive DID NOT mention 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 NHIA is undergoing a period of melioration, which began in 2008. Key stakeholders attest to the improvements in the NHIS. Mass registration exercises are also expanding its coverage of the population.
The initiatives instituted since 2009 to improve the efficiency of the operations of the scheme include the following:
• The institution and fine–tuning of Clinical Auditing to promote quality of care and reduce abuse and malpractice at healthcare facilities. The audits instituted in 2008 have so far resulted in the recovery of over GHC 21 million from providers in false claims.
• Improvement in claims administration with the establishment of a state-of the–art Claims Processing Centre (CPC) improving the claims processing turnaround time.
• Reforms in the Provider Payment System with the piloting of Capitation in Ashanti Region which, despite initial difficulties, is providing useful lessons and informing plans for a possible country-wide scaling-up in 2013. When fully implemented it is expected to rationalise the utilization of primary-care and eliminate or reduce healthcare shopping and other abuses.
• The introduction of a Consolidated Premium Account to collect payments made at the scheme level into one composite account to ensure greater accountability and to improve efficiency in the financial operations of the scheme.
• The completion of the necessary processes for electronic linking of treatment to diagnosis to facilitate electronic claims processing and inject speed and efficiency into the NHIS claims management and payment system.
• The design and successful piloting of a new Prescription Form to minimise abuses in the prescription and dispensing of medicines.
• The upgrading of the ICT system through the creation of an ultra modern data centre.
• The delivery of the medium term Strategic Plan (for the first time), developed with stakeholder collaboration to guide the Authority and Scheme.
• The review of the Legal framework guiding the NHIS is in its final stages before parliament
• The latest addition to the NHIAs catalogue of initiatives is the establishment of the NHIS Call Centre which addresses issues, enquiries and complaints of NHIS subscribers and other stakeholders expeditiously, thereby empowering them and optimising their experience of healthcare on the NHIS. Trained agents are on hand at the 30-seat call centre 18 hours a day (6am to 12 midnight), seven days a week, to provide assistance to callers in English, Ewe, Hausa, Akan, Dagbani and Ga. Callers can reach the NHIS Call Centre on 054 444 6447 on all networks (and shortcode 6447 for MTN and Vodaphone subscribers)
• 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.
On the global stage, Ghana’s Health Insurance Scheme continues to attract international attention and recognition as an emerging model of healthcare financing for countries in the Developing World and beyond. Ghana has become a destination for delegations from foreign countries and institutions seeking to learn from Ghana’s experience, just as the NHIS also learns from best practice around the world.
The study tours by visiting 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. Such achievements are worth celebrating by all Ghanaians irrespective of political persuasion.
With the international interest and confidence in Ghana’s health insurance scheme, offers of assistance have started to come in from external sources such as South Korea and the United States.
In May 2012, significant direct assistance was offered to the NHIA/NHIS by the United States Agency for International Development (USAID). The visiting USAID delegation noted that the cost containment strategies of the NHIA sit very well with the priorities of USAID, and that the Agency aimed at interventions that would have an impact on the health of the people of Ghana.
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