Delayed payment of NHIS claims hindering smooth healthcare services

The delays in the payment of claims to National Health Insurance Scheme accredited health facilities in the country is affecting the smooth running and provision of healthcare services nationwide.

This was revealed by the Member of Parliament for Nadowli/Kaleo, Anthony Mwinkaara Sumah on the floor of Parliament.

According to him, the late payment of the claims serves as a disincentive to health facilities.

Making a statement in Parliament today, Monday, March 29, 2021, the MP urged government to provide the National Health Insurance Authority with adequate and timely funding to fulfill its “most important obligation of prompt subscriber reimbursements for services rendered.”

Mr. Sumah stated that although the National Health Insurance Scheme was brought in to assist the citizenry in the area of health by taking away the financial burden on them, the scheme seems to be gradually fading out as most health facilities are going back to the cash and carry system.

“The most crucial and debilitating challenge of the NHIS is the delayed and inadequate reimbursement of claims to accredited health facilities. Unquestionably, this has affected negatively the ability of these facilities to provide quality healthcare to the citizenry. In response to these challenges and as a mechanism to sustain the health facilities and makeup for the funding inadequacies, managers of these institutions have resorted to instituting fees and charges, or better still reversed to the cash and carry system albeit illegal.”

He added that “the gradual and subtle reintroduction of cash and carry system, out-of-pocket payment or co-payment/supplementary payments, the potential to attain UHC, financial risk protection for the poor and the vulnerable, access to essential quality healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all by 2030 as contained in SDG 3 cannot be guaranteed.”

Below is the full statement read by the Nadwoli MP:

DELAY IN REIMBURSEMENT OF NHIS CLAIMS, ILLEGAL CHARGES AND IMPLICATIONS ON ACCESS TO QUALITY AND EQUITABLE HEALTH CARE: A STATEMENT BY HON. ANTHONY MWINKAARA SUMAH MEMBER OF PARLIAMENT FOR NADOWLI/KALEO

Mr Speaker, thank you for the opportunity to make a statement on the effects of delayed/ inadequate reimbursement of national health insurance scheme claims to health facilities and its attendant implications on access to healthcare services and the health of the citizenry.

Rt. Hon. Speaker, its often said that ‘health is wealth’ to underscore the basic fact that a healthy population guarantees sustained productivity while the converse impoverishes individuals, households and the nation as a whole. In fact, Ghana acknowledged the importance of health to creating wealth and featured this prominently as a major theme in the 2007 health policy document for the country. This is premised on the fact that lack of access to quality and equitable healthcare negatively affects productivity and occasions adverse impacts on individual and household incomes as well as state resources.

However, a healthy population is a function of several indicators or factors of which financial access to healthcare services is fundamental.

Mr Speaker, at independence, all user fees were eliminated in government health facilities and by early 70s, the policy had changed to partial or co-payments of fees at the point of care, a situation that undermined access to equitable care by all Ghanaians. Therefore, as a result of the need to create financial access to healthcare, protect the populace particularly the poor and vulnerable against financial risk and to do away with the retrogressive cash and carry system which placed huge catastrophic burden on the populace, this august house passed the National Health Insurance Act 2003, ACT 650 and subsequently the National Health Insurance Act 2012, Act 852.

The NHIS law sought to totally abolish the “cash and carry” system introduced in the 1980s. Additionally it sought to ensure more equitable financing of health care, equity in healthcare coverage, elimination of financial barriers to healthcare access, and protection of the poor and vulnerable against financial risk arising from catastrophic healthcare expenditure.

Mr Speaker, it is worth noting that the introduction of the national health insurance scheme has yielded positive impacts in respect of financial access to healthcare. These facts are well established, and backed by a large body of literature to include improved health seeking behaviour and utilisation of healthcare services, removal of financial barriers to healthcare services and increased access to healthcare.

Rt. Hon. Speaker, notwithstanding the positive outcome of the implementation of the national health insurance scheme, the scheme is persistently beset with a myriad of challenges including implementation of the indigent policy, high deficits by the scheme and financial mismanagement among others.

However, the most crucial and debilitating of all is the delayed and inadequate reimbursement of claims to accredited health facilities. Unquestionably, this has affected negatively the ability of these facilities to provide quality healthcare to the citizenry. In response to these challenges and as a mechanism to sustain the health facilities and makeup for the funding inadequacies, managers of these institutions have resorted to instituting fees and charges, or better still, reversed to the cash and carry system albeit illegal.

Rt. Hon. Speaker, across the country these charges vary from full cost recovery, co-payment, supplementary payments to unbundled charges for diagnostic services such as x-ray, ultrasound and laboratory services among others. The form and rates of these charges are determined absolutely by managers of these health facilities and levied against clients irrespective of the fact that they are enrolled under the NHIS and as such are entitled to free healthcare. This phenomenon has resulted in numerous adverse implications. However, Rt Hon

Speaker, for the purpose of this statement I will limit my submission to financial access considerations arising from the request for out-of-pocket payments from the citizenry at the point of care.

Rt Hon Speaker, foremost, the citizenry is unable to access basic healthcare services due to their inability to afford out-of-pocket payments. As such, these payments serve as a major barrier to access to healthcare services. As a result, persons who require healthcare services do not avail themselves to the health facilities unless they are in very critical conditions, which often lead to negative treatment outcomes and high mortalities in our health facilities. Also, the populace is increasingly relying on self-treatment and alternative healthcare or medicines whose efficacy and safety cannot be guaranteed.

Secondly, the situation has adversely affected access to medicines. Besides clients being asked to make out-of-pocket payment for medications at these facilities, the health facilities also lack adequate funding to stock their dispensaries because of the debilitating effect of the delay/inadequate reimbursement on the facilities’ drug revolving funds. Additionally, most facilities have also exhausted their credit lines because of their high indebtedness to drug companies and suppliers. As a result, the cost burden of acquiring medications has been shifted to the poor client who would have to procure the required medications from third party pharmacy/ chemical shops where NHIS insurance enrolment is of no consequence in terms of paying for medication.

Thirdly, the general populace is growing indifferent to enrolling on the NHIS because in their view it does not guarantee them financial access to healthcare services at the health facilities which is further worsening the access and equity gap in healthcare. This phenomenon may account for the decreasing enrolment and renewal rate that has characterised the NHIA particularly from 2017 till date as some surveys have reported.

Lastly, Rt. Hon. Speaker, there is evidence of differential treatment offered to clients seeking healthcare services at the health facilities under the NHIS benefit package compared to their counterparts offering out-of-pocket payment. Predominantly the latter have been preferentially treated while the former have severally reported negative attitude from healthcare providers. The situation has therefore affected negatively the utilization of healthcare services by insured clients.

Rt. Hon. Speaker, as a member of the global health community, Ghana has signed onto the Sustainable Development Goals and Universal Health Care (UHC) by 2030. As a signatory to these major global commitments, it is imperative for sound health policies such as the NHIS to be implemented. However, with the gradual and subtle reintroduction of cash and carry system, out-of-pocket payment or co-payment/supplementary payments, the potential to attain UHC, financial risk protection for the poor and the vulnerable, access to essential quality healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all by 2030 as contained in SDG 3 cannot be guaranteed.

Rt. Hon Speaker, it is therefore imperative to address this phenomenon. Essentially, the delay/inadequate reimbursement of NHIS claims to accredited healthcare facilities should be given a serious view. The NHIA should be provided with adequate and timely funding to fulfil their most important obligation of prompt subscriber reimbursements for services rendered. The tariffs for medicines and services should also be reviewed with the full participation of service providers to agree on realistic service delivery costs that will not encourage illegal or additional charges passed on to innocent clients. The institution of illegal charges for insured clients should be investigated towards resolving any challenges therein. It is only through this that we could give meaning to the provisions of the NHIA Act 2012, ACT 852 which was passed by this august house to ensure financial access to healthcare and by extension UHC.

In conclusion, Rt. Hon. Speaker, we need to remind ourselves that access to healthcare is a fundamental and an inalienable right to every Ghanaian and we are obliged as the representatives of the people to take the necessary steps to guarantee the realisation of this right. In the context of the COVID-19 pandemic, it is crucial for these access barriers at our health facilities to be resolved / eliminated to improve logistics and medicines availability for quality service delivery to our people.

On this note Rt. Hon. Speaker, thank you once again for the opportunity to make this statement.

Source: Modern Ghana

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