The National Health Insurance Authority (NHIA) has cautioned accredited healthcare providers to refrain from charging illegal fees, also known as co-payment.
The practice, it said, flouted Act 852 which governed the scheme, violated the contractual agreement between the authority and credentialed health providers.
According to the authority, the practice had also culminated in the decline in membership enrolment and renewals over the past years despite numerous interventions such as mobile renewals, linkages between the NHIS card and the Ghana card to enhance portability and mass registration, among others.
Consequently, the authority has commenced engagement with stakeholders, especially tertiary and secondary health providers in Accra, to brainstorm the way forward before any action could be taken.
Situation
The Chief Executive Officer of the NHIA, Dr Bernard Okoe Boye, said: “The practice has assumed an alarming dimension to the extent that it is now becoming a norm rather than an exception”, adding that six out of 10 complaints made to the authority were about co-payment.
He said another worrying observation was that some accredited healthcare facilities were detaining NHIS members over such illegal payments.
Dr Okoe Boye further said that a survey on co-payment conducted by the authority revealed that the practice was pervasive across the country.
He said at the tertiary and secondary care levels, NHIS members were made to pay for most services, including laboratory investigations and about 80 per cent of prescribed medications.
“At the primary care level, apart from blood film for malaria, all other laboratory investigations and about 50 per cent of medications prescribed are paid for by members, in addition to other services,” the CEO added.
Dr Okoe Boye said the scheme in its 19-year journey had undergone several policy and operational reforms through stakeholder engagements and consensus building to improve efficiency, enhance quality of health care, and also ensure sustainability.
According to him, there had been significant improvement in the utilisation and access to health care, with over 90 per cent of outpatient department attendance in public institutions and 70 per cent in credentialed private health institutions being members of the scheme.
He also said that claims submitted for services rendered were currently in excess of GH¢120m, becoming the major contributor to the internally generated funds of most public institutions and a boost to expansion in health infrastructure.
Interventions
Dr Okoe Boye further said that the authority had taken steps to address concerns of both members and providers by establishing information desks at some facilities to assist the public.
It has also formed a multi-stakeholder group of experts to review tariffs and prices of medicine through a transparent process to reflect the prevailing economic conditions and other health indices.
He also said more attention was being given to payment of claims to mitigate challenges associated with delays in reimbursement, as well as the inauguration of co-payment committees across all levels in the authority’s operations to promptly attend to the needs of members and providers.
In a speech read on behalf of the Minister of Health, Kwaku Agyeman Manu, by a Director at the Ministry, Dr Baffour Awuah, he said it was incumbent on service providers, especially those from public health facilities, to help curb the increasing use of co-payment which he described as illegal.
“We are not here to talk about the problem, our objective is how do we stop co-payment. We should not minimise it, we must stop it entirely,” he added.
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