NHIA CLEARS ARREARS TO PROVIDERS
The National Health Insurance Authority has paid claims totaling GH¢376,426,124 to NHIS accredited healthcare service providers in the country for the period 2009. The amount was made up of GH¢270,631,610 paid out in 2009 and GH¢105,794,514 paid to service providers from January to May, this year, 2010 in respect of outstanding 2010 claims.
This means that the NHIA paid out some GH¢211million more for 2009 claims than the GH¢165million spent on claims for the year 2008. The National Health Insurance Authority is currently making feverish preparations to pay off outstanding arrears from January this year by July, 2010.
Claims paid out by the NHIA now account for between 50 and 90 percent of internally generated funds (IGF) of public health institutions, while accounting for between 80 and 100 percent of the incomes of some private service providers.
Far from crippling service providers, as claimed by some medical practitioners, the NHIS is now the financial mainstay of a good number of accredited healthcare service providers in the country. It provides ready sources of funds for the procurement of about 80 percent of drugs, medical consumable and other services as well as being the source of funding for capital projects and logistics and vital equipment for some service providers.
The Authority would however like to point out the worrying trend of increasing claims malpractices being carried out by services providers as revealed by the results of clinical audits conducted by the Authority in recent times. Increasingly, hospitals, clinics and maternity homes are found to have indulged in malpractices such as alteration of diagnoses, irrational prescription of drugs, billing for services not rendered, diagnoses not consistent with treatment, wrongful application of tariffs, all in a bid to increase their incomes through fraudulent means.
Delays in the payment of claims can only be solved through effective collaboration between the NHIA, the District Schemes and providers. In pursuant of that effort, the NHIA organized a stakeholders joint meeting in Kumasi this year, from 7 to 9 April, which was attended by Regional Medical Directors and Medical Superintendents of the Ghana Health Service (GHS), the Christian Health Association of Ghana (CHAG), Community Practice Pharmacists, as well as staff NHIS District Schemes, where there were deliberations on the best ways of collaborating in the implementation of the National Health Insurance Scheme.
In addition to the above, the NHIA has far advanced in its quest to establish an electronic claims processing centre which would be operational by the end of the year. This would help to quicken the processing of claims. The Authority has taken over the processing and payment of claims of the three Teaching Hospitals and the ten Regional Hospitals in the country all in an attempt to quicken the process of claims vetting and payment in order to relief service providers of delays and difficulties in the payment of claims.
The collaboration of service providers generally, in the implementation of the NHIS is imperative to the success of delivering an affordable and quality healthcare to Ghanaians. In that regard, the Ghana Medical Association, the Ghana Health Service and the Christian Health Association of Ghana have responsibilities to support the NHIA in its efforts to eliminate fraud from the NHIS. The situation where over 30 per cent of claims from providers are found to be fraudulent is not acceptable and represents the single most dangerous threat to the sustainability of the NHIS which must engage the attention of all stakeholders in the healthcare sector.
Eric Ametor-Quarmyne.
(Deputy Director, Corporate Affairs
& Strategic Direction)
