NHIA OUTLINES KEY REFORM INITIATIVES
The National Health Insurance Authority has outlined its immediate strategic objectives in its drive to overhaul the National Health Insurance Scheme. Details of its reform initiatives emerged during the recent two-week whirlwind countrywide tour by the Chief Executive Officer and senior management personnel of the Authority which included scheduled training engagements with staff from all the 145 District Mutual Health Insurance Schemes in the country and ten regional offices of the Authority.
The tour signaled a significant change in the operational dynamics and methodology of the NHIS to meet the challenges posed by systemic abuses and fraud and the consequent exponential cost escalation in the NHIS.
Announcing the measures, the Chief Executive Officer, Mr. Sylvester Mensah, identified cost-containment as one of the key objectives in the drive for sustainability of the NHIS. Subsequent to this objective, he detailed various strategies designed to combat abuse and fraud responsible for the financial hemorrhage in the Scheme, which, together with other challenges, had necessitated comprehensive arrangements to plug the leakages in the system, strengthen internal controls, inject accountability into the NHIS, and ensure that the Scheme gets value for money from service providers. Consequent key reform initiatives being implemented include:
1. The setting up of a Consolidated Premium Account which would be operational from July 2010. Scheme managers will be required to deposit all premiums collected into a centralized account in either of two designated banks with a nationwide reach – Ghana Commercial Bank and Agricultural Development Bank, with an identification code for each Scheme account. The Schemes have been directed to close all other accounts. This would redress the current situation where more than 70% of premiums collected are not properly accounted for.
2. The establishment of a Consolidated Claims Management Centre in Accra, a pilot project to manage claims from the Teaching Hospitals and ten Regional Hospitals, operational from July 2010, and manned by experienced and competent claims personnel. This would provide a greater capacity for vetting of claims and efficient payment of service providers. If successful, the format would be rolled out in zonal claims processing centres across the country.
3. Requirement for a Payment Plan before the disbursement of funds: Scheme Managers will henceforth be required to produce and forward a payment plan in advance to the Authority for endorsement, before funds are released for disbursement to service providers in order to combat irregularities in payments arrangements.
4. Introduction of a standardized NHIS Prescription Form which requires the Personal Identification Number (PIN) of the prescriber and of the dispenser, and identifies the Scheme involved; also designed to check systemic abuse and fraudulent practices in the dispensing of medicines.
5. Streamlining of procedures for registration under the Free Maternal Care programme. Following the streamlining, pregnant women would be required to register for free, first, before accessing free maternal care with effect from July 2010. This is intended to eliminate abuse of the programme.
6. Disaccreditation of all private healthcare facilities run by full-time operatives in public health facilities to eliminate conflicts of interest and double billing of the NHIA for services to patients.
7. Introduction of Capitation for Out-Patients Department services in primary healthcare facilities following a pilot programme to be carried out in a selected region scheduled to start by the end of 2010. Capitation would be based on research into utilization rates and costs, projected over a whole quarter, and involve advance payments to service providers subject to periodic reviews and adjustments. It is expected that it would introduce efficiency and drive down costs in primary healthcare delivery.
8. Implementation of a unitary system of contracting with service providers. Under the review, contractual arrangements will involve apex bodies such as the Ghana Health Service (GHS), National Health Insurance Scheme (NHIS), Christian Health Association of Ghana (CHAG) and other service providers.
Staff from all the 145 District Mutual Health Insurance Schemes in the country have been trained in the use of a new financial and operational reporting tool developed by the Authority. The new reporting format is designed to streamline and standardize the electronic recording and timely transmission of accurate data by the Schemes to the Authority for efficient planning. It is expected to improve financial and operational discipline at the Schemes, and ensure prompt processing and payment of claims to service providers. Trends in the data would also be useful for evaluation and monitoring purposes. The sessions with staff from the various District Schemes and Regional offices also involved a review of staffing levels and arrangements to improve the resource and staff capacity of the various Schemes.
The action-oriented tour marks an injection of fresh impetus into the operations of the Authority with a contingent impact on the Schemes. A palpable sense of purpose and direction and a discernible optimism continue to breeze through the corridors of the Authority, despite the acknowledged challenges, deriving from the clarified set of strategies.
Nii Anang Adjetey
Corporate Affairs & Strategic Direction