13 Aug 2016

NHIS; A Challenge To Quality Healthcare Delivery

The National Health Insurance Scheme (NHIS) is a form of National health insurance established by the Government of Ghana, with a goal to provide equitable access and financial coverage for basic health care services to Ghanaian citizens.[1]

Foreigners were supposed to pay cash whenever they access healthcare services in Ghana because it was assumed such people could afford it. Besides, most of them never pay tax to the government.
It was not until 2009 when the scheme was changed from its district-based mutual status to a nationwide status that foreigners began infiltrating its system. And it was also the time the problems of health insurance began to surface.


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Some of the NHIS offices are packed with unqualified staff. Clients names are often wrongly spelt. Some clients names and pictures are even interchanged.
National health insurance scheme

Most of the workers are just criminals who employ any means they can to cheat the system. People's ages are either reduced or increased to qualify them to be registered as either being among the core poor clients or underage. This is mostly done on the blind side of registrants some of whom are mostly illiterate and can't give accurate ages or dates of birth. Although these members pay for registration and renewal, the monies enter into private pockets. Some district managers of the scheme even connive with workers under them to engage in these activities.


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Foreigners are sometimes charged exorbitant fees before being allowed to register as Ghanaians. The money charged finds its way into the pockets of greedy NHIS staff, most of whom don't have any requisite qualification to occupy such offices.

Imagine a Fulani family which goes to register and is charged an exorbitant amount of GHC 250 per head. The staff tells this family that it is a form of help they are being given because they are not Ghanaian citizens. This family, which may comprise of five members or more agree to pay the charged amount and are registered as Ghanaians. This staff has succeeded in making more than GHC 1000 instantly in connivance with other staff!

The NHIS now dictates what medicines a client gets in a healthcare facility. There is a restricted list of medicines to prescribe for the various ailments, going out of which makes your claims of services rendered invalid for reimbursement. There is even a limited list of diagnoses to follow. Any prescriber who prescribes out of that list is doing a fruitless job for the health facility because such claims forms will not qualify for reimbursement. Some prescribers sometimes overestimate the diagnosis of some conditions to make the claims form valid.


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Reimbursement is no longer done on a quarterly basis. It is now done at the whims and caprices of a certain manager who sits in the capital city of Ghana without any knowledge of what pertains in remote villages such as can be found in northern Ghana. There are times when certain hospitals and clinics run out of baseline drugs and have to partially halt operations until reimbursement is done.

The district hospitals, which act as primary referral facilities, bear the brunt of the CHPS compounds and health centers. Some district hospitals have to always resort to loans from banks to buy basic consumables and baseline drugs just to keep afloat, awaiting reimbursement from Accra. There are currently some hospitals with more than a year's outstanding arrears to collect from the National Health Insurance Authority (NHIA), the responsible for running the NHIS.

The national NHIA boss was heard on air saying they have enough money for reimbursement to all health facilities. He, however, said they had a technical problem which is making it difficult to reimburse claims. But, how technical could this problem be that it can't be resolved in a year?


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And worse of it all, the targeted beneficiaries of health insurance are not deriving any benefits from it. They don't even know when their cards would expire. They only get to realize it when they are sick and come to the hospital. Others still believe so much in traditional medicine and superstition that they often delay at home and get to the hospital in a critical state. Most of these people often can't renew their cards instantly and use them. Even if they renew, it has to take a whole month for such cards to be active. They, therefore, have to always fork money out instantly to pay for all services rendered them.

People who can afford to pay their bills in cash are those rather benefitting from the health insurance. They even renew it a month before it expires so they can be covered throughout the year. And they are those who patronize health facilities almost on a weekly basis. An abuse of the system you may say.

How long is this going to continue? How long will the NHIS continue to cripple health facilities with debt? How long should healthcare facilities suffer in an effort to deliver appropriate care to clients because of NHIS?

2 comments:

  1. That the NHIS is extended to Foreigners in Ghana and to people on visit to Ghana is laudable feat.
    That the whole system of Registration is done on the spot with cash exchange is wrong.
    Registrants could pay their registration and annual service fee at the bank and then turn in receipts of payments at the NHIS desk for their cards.
    This will avoid the cheating
    It will also give some credit and trust to the NHIS officers,

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    Replies
    1. My brother, don't you think extending the NHIS to foreigners may be accounting, in part, for the current challenges the system is facing? Now, there is so much pressure on the system than it can bear.

      Your proposal for premiums to be paid at banks is a fantastic one. The problem however is that banks are not easily accessible in most communities in Ghana.

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