NHIS stakeholders want suspension of capitation

Stakeholders in the health sector, on Friday called for the suspension of the capitation payment method of the National Health Insurance Scheme (NHIS), until a proper review has been done to pave way for national implementation.

They said the capitation being piloted in the Ashanti Region, has encountered a number of difficulties that go against providers and subscribers.

Dr Kwabena Opoku Adusei, President of Ghana Medical Association said the Association is against the form and manner the capitation is being implemented.

He asked why the programme, which was initially billed to be piloted for six months in the region, has been extended to two years.

The stakeholders meeting was organised by the Ministry of Health to afford participants the opportunity to discuss the implementation of the capitation payment to healthcare service providers under the NHIS.

Capitation is the payment system in which all medical experiences are paid in advance to providers to cater for health care services of subscribers under the preferred primary provider system.

Dr Opoku Adusei noted that there is no service fee under the capitation, hence the need to evaluate it in view of the current economic trend.

He called for continuous education throughout the country before the capitation is rolled out.

Sherry Ayittey, Minister of Health said the introduction of the National Health Insurance Authority (NHIA) as an additional provider payment mechanism of the NHIS in Ashanti Region, had encountered varied reactions from many people and therefore a technical sub-committee was set up to monitor and evaluate the programme.

She said after the consultations the capitation would be rolled out nationwide.

Ms Ayittey was optimistic that by 2020, the NHIS is expected to reach everywhere to make it universally accessible to all people, especially the vulnerable in the society.

According to her, apart from exemptions like free maternal and mental health care being catered for under the NHIS, family health comprising counselling and distribution of family health commodities would be introduced to the scheme this year.

Sylvester Mensah, Chief Executive Officer of NHIA, said the NHIS is going through difficult times and therefore hailed the meeting as essential to help find ways of sustaining the efficiency of the scheme.

He said the tripod of providers and subscribers of the scheme, on which the health insurance hinges on, is fraught with challenges.

Mr Mensah added that some subscribers and providers are engaging in fraudulent activities and therefore endangering the scheme.

He said some subscribers go to providers and collect medication for their relations who are not on the scheme at the expense of the NHIS, while some providers also share list of data on subscribers who visit their facility with other providers, who use the same claims sheets to request for reimbursement from the Authority.

Mr Mensah said some providers give more medicine to subscribers than prescribed because they want to sell their medicines.