The Ministry of Health is on course to scale up the phased implementation of the NHIS capitation provider payment mechanism which started as a pilot in Ashanti region.
The Ministry held a stakeholders’ meeting last Friday to brainstorm on options for scaling up the payment system across the country.
Capitation is a provider payment method in which providers are paid, typically in advance, a pre-determined fixed rate to provide a defined set of services for each individual enrolled with the provider for a fixed period of time.
The amount paid to the provider is irrespective of whether that person would seek care or not during the designated period.
Health Minister, Sherry Ayittey who presided over the meeting expressed the hope that capitation would be extended to all parts of the country.
She expressed government’s commitment in ensuring that the NHIS succeeds. The Minister said “government is committed to the road map to achieving Universal Health Coverage” and the NHIS remains a crucial vehicle in that respect.
Chief Executive of the NHIA, Sylvester Mensah in his address at the program remarked that “globally, capitation has been recognized as the most efficient system in the payment of health providers.”
According to him, the two other payment systems the NHIA is using (Fee for service and the Ghana Diagnosis Related Groupings-GDRG) have had various degrees of challenges and the introduction of capitation as an additional payment mechanism was a way to inject more efficiency into the claims payment regime of the NHIA.
A monitoring and evaluation report on the pilot presented to stakeholders by the chairperson of the Technical Sub-committee on Capitation, Professor Irene Agyapong, noted that capitation represents one of the best ways of improving the country’s provider payment regime but submitted that the challenges and deficiencies associated with the implementation of capitation in the Ashanti region could be attributed to a general systems failure and partisan politics.
Prof. Agyepong further stated that other factors that negatively affected capitation payment implementation were resource constraint and lack of an enabling environment.
She said complex reforms could only be effective if power was diffused rather than concentrated at the top and urged the Ministry of Health to play a lead role in addressing the challenges associated with the implementation of capitation.
Various stakeholders have expressed concerns and different positions on the introduction of the capitation payment method.
It would be recalled that the introduction of the system was met with agitations in Ashanti.
The agitations led to some trade-offs between service providers in the region, the health ministry and the NHIA to refine the system to what it is now.
Some of these trade-offs according to Prof Agyepong included an increase in the capitated rate, the removal of medicines from the capitation basket among other things.
The meeting concluded with a call on the Ministry to deliberate on what to do with the pilot ongoing in Ashanti, refine the manner and form of capitation as it is now and define the mode of the nation-wide scale-up.
The meeting was also attended by various leaders in the health sector including Dr Opoku Adusei, President of the Ghana Medical Association, Joseph Yieleh Chireh, Chairperson of the parliamentary select committee on health, Dr Richard Anane, a former Health Minister and Dr Nii Ayite Coleman of the Ministry of health.
