There is no doubt that the greatest asset of any country is its citizens because their general well-being largely determines the overall progress and development of the national economy. An enhanced quality of life means higher productivity since very little of the country’s budget would be spent on health facilities and the treatment of diseases. Any country that has an unhealthy population is bound to suffer in many ways in terms of developmental programmes.
Health and poverty, according to the Global Forum for Health Research (1999), are intricately linked and poverty is often associated with ill health. Therefore governments have embark on various programmes to provide effective health care services to her people.
Ghana has had a chequered history of healthcare financing options and as the country approaches her 60th anniversary it is necessary to take a look at our current health financing options.
There had been certain times when health services were provided free of charge and other times when user fees were charged, popularly known as the “cash and carry system”. I believe that it was in pursuit of a sustainable national healthcare financing regime offering high standards, affordable and accessible healthcare to Ghanaians that the Government of Ghana, with a statutory enactment of the National Health Insurance Act, (Act 650) in 2003, which has been repealed and replace with Act 852, 2012. The NHIS has been the system of healthcare financing in Ghana since then.
Despite the significant successes that the NHIS has chalked in its near-decade of existence, one key challenge that is bedevilling the NHIA is the myriad of financial challenges that the scheme is confronted with. The spill-over effect of the financial circumstances of the NHIS is stifling some service providers under the scheme in the private sector, such as members of the Ghana Registered Midwives Association (GRMA). GRMA members who are currently accredited as service providers under the NHIS are suffocating under the mammoth financial burden that the scheme is currently exerting on them.
At the inception of the scheme, GRMA members could rely on regular monthly payments of parts of the claims submitted to the scheme. However in the past few years it has become a “normal” abnormality for service providers not to receive any payment at all for periods ranging from three (3) to six (6) months, or more.
Unlike Act 650 which stipulated in section 71 (1) that:
“Tariffs payable to healthcare providers shall be paid within four (4) weeks by schemes to the healthcare providers directly”.
The new National Health Insurance Act, 2012 (Act 852) does not specify any time frame within which claims presented by the service providers to the NHIA should. Section 36(6) states that:
“The Authority shall pay not less than a portion of the face value of the claim of a healthcare provider after a specified period to be determined by the Minister acting in consultation with the Authority and healthcare providers.”
According to section 36(6) of Act 852, the NHIA is not obliged to pay service providers within any specified period, which we at GRMA find as unfavourable to our members who are accredited as service providers to the scheme.
As a result, the current undue delays in the payment of claims to service providers under the scheme particularly, GRMA members, and the operations of such members are suffering several adverse implications such as:
•Lock up of substantial proportions of our capital
High levels of indebtedness of members to suppliers and financial institutions
•Threat to the business viability of GRMA members operating as service providers to the scheme
Significant loss of real value of income
•Increased possibility of compromised quality of care offered by GRMA members under the NHIS
Interestingly Legislative Instrument (L.I) 1809 is still being used for the enforcement of the new National Health Insurance Act (Act 852) since a new L.I is yet to be developed and laid before Parliament.
It is in the light of this, and other related ramifications of the undue delay in the payment of claims by the scheme to its service provider that the GRMA is pursuing this advocacy action under the auspices of the Business Sector Advocacy Challenge (BUSAC) Fund. This is to explore options available to us as stakeholders in fashioning out a feasible claims payment mechanism by the NHIA to service providers. This will eliminate undue delays in the payment of claims to service providers of the scheme operating in the private sector.
In our quest to find not just a suitable but also sustainable claims payment regime for service providers under the NHIS, GRMA wishes to ask certain pertinent questions that include the following:
•Does the scheme currently have in place efficient and sustainable cost containment mechanisms?
•Is the current subscriber base broad enough to provide the required financial support to the scheme?
•Are the premium paid by subscribers based on the application of any actuarial principles?
•Is the current 2.5% National Health Insurance Levy (NHIL) on VAT enough?
•Does the NHIL deduction get to the NHIA in time?
•Can the current claims pays processing procedure be made less cumbersome and time consuming?
How can we minimize corruption/collusion and attendant effects on the scheme?
•Can we use a part of the proceeds from the National Health Insurance Levy (NHIL) as collateral to the financial institutions and put in place a payment arrangement where service providers can be paid regularly by the financial institutions, as recommended by Mr. Paul Victor Obeng (Chairman of the National Development Planning Commission) once their claims are cleared by the NHIA?
We, at GRMA, have some fair appreciation of the enormity of the challenges facing the scheme managers. However we do not believe that the current undue delays in the payment of claims are acceptable and sustainable for GRMA members in particular and all service providers in general. The status quo is gradually killing midwifery not only as a viable healthcare service in the private sector, but more so as a business within the private sector of our national economy. The implications of allowing these long delays to persist are dire not only for GRMA members, but also the nation especially in our quest to achieving the Millennium Development Goals (MDG) 4 and 5.
It is in the light of the foregoing that the GRMA is entreating the Ministry of Health to broaden its consultation process leading to the development of the L.I for the National Health Insurance Act 2012 (Act 852) to enable the GRMA make vital input to ensure that the LI. is adequately responsive to the needs of service providers under the NHIS who are operating from the private sector of our national economy.