Service providers complain of delays in payment of claims

Mr Frank Torblu, the Executive Director of the Health Insurance Service Providers Association, has expressed worry about the delay in the payment of the National Health Insurance Scheme (NHIS) claims.

Mr Torblu said the situation had affected the smooth-running of the scheme, and urged government to ensure the timely release of funds for the payment of the claims to help improve health delivery.

He was speaking during a panel discussion in Accra on Ghana Journalist Association programme dubbed: ‘Business Advocate’ on Ghana Television supported by BUSAC Fund, Embassy of Denmark and the United States Agency for International Development (USAID).

Speaking on the topic: “The implementation of the NHIS, and the effects on the country,” Mr Torblu commended government for initiating the scheme, but said it only covered 38 per cent of the population.

He was of the view that there should be the creation of a separate regulatory body, to spearhead the affairs of private health insurance,

Mr Torblu expressed concern about the inability of authorities to involve service providers in policy formulation before the law on the scheme was passed, hinting that their outfit had to write to Parliament and the Ministry of Health on some of their concerns.

He called for a review of the scheme’s medicine list, since most of the medicines were not on the insurance list.

The capitation grant should be across board, and not for some selected regions, saying it brings disparity in the payment mechanisms to the providers who are providing equally the same services across the country.

He called for broader consultation with stakeholders to address some of the pertinent issues affecting the scheme.

Mr Selorm Kodzo Adonoo, Deputy Director of Communication, National Health Insurance Authority (NHIA), explained that the Scheme was a social policy intervention that ensured access to basic healthcare services to all citizens.

Mr Adonoo said the Authority was established under the National Health Insurance Act 2003, Act 650, as a body corporate, but a new law, Act 852 had replaced ACT 650 in October 2012, to consolidate the NHIS, remove administrative bottlenecks, introduce transparency, and reduce opportunities for corruption.

He said currently the Scheme had a membership of 10.54 million as of 2014, ensuring equity in health care coverage, access by the poor to healthcare services and the protection of the poor and vulnerable against financial risk.

Mr Adonoo said the establishment of a separate regulatory body to run the private insurances was not necessary, adding that the Authority was up to the task to perform such functions in an effective and efficient manner.

He said the Authority had 160 districts offices across the country, as part of its decentralization process, and was committed to provide financial risk protection against the cost of quality basic health care for all.

Mr Adonoo said the scheme medicine list was based on a broader consultative discussion by stakeholders, and found it absurd for individuals to blame the Authority for failing to exclude some of the drugs from the list.