Delayed payment by insurance schemes affecting hospital services

Koforidua, July 11, GNA - Health Insurance Schemes are owing the Eastern Regional Hospital at Koforidua more than three billion cedis, or 300,000 Ghana Cedis as at t he end of June this year, the hospital's management has said.

Dr Obeng Apori, director of the Hospital, said the situation was seriously affecting the smooth operations of the hospital but denied early reports that the hospital was considering the withdrawal of its services to the schemes.

He explained that members of the scheme who had paid their premiums had honoured their obligations to the schemes and so it would be unfair for the hospital to refuse to provide them with the required services. Dr Apori said if anything, it was the management of the schemes and the National Health Insurance Council that had failed to honour their obligations and needed to be taken to task.

He said further delay by the schemes to pay the hospital would put unnecessary stress on its services and could even lead to the collapse of the hospital.

He held that the indebtedness to the Regional Hospital was caused by the way the scheme managers and the National Health insurance Council were handling the payment of service providers.

Dr Apori said by an agreement, the schemes within the region were expected to pay 70 per cent of the bills submitted by the Regional hospital immediately they received the bills, while the remaining 30 per cent was to be paid after the vetting of the bills.

He explained that most of the District Mutual Health Insurance Schemes had no resources to pay for the 70 per cent of the monthly bills as agreed upon and would have to apply to the National Health Insurance Council for support.

By such arrangement, he observed, it could take about four weeks before the 70 per cent of the bill is honoured. Dr Apori said due to the slow nature of the vetting procedure, some of the schemes had not honoured the second part of the bills submitted to them for almost four months.

As a way out, he suggested an improvement in the capacity and numbers of staff at the schemes' claims office so that the vetting process could improve.

Dr Apori also suggested that after a year or two experiences; the National Health Insurance Council should estimate and advance a budget to the schemes to use in the payment of their monthly service bills and monitor to help improve upon the payment procedure to reduce the stress put on service providers.

Currently, the Regional Hospital is providing service to eight District Mutual Health Insurance Schemes and six institutional and co-operate schemes.