Health insurance capitation critic now welcomes programmes
A strident critic who vehemently opposed the introduction of the capitation under the National Health Insurance Scheme in the Ashanti Region for years, has finally welcomed the scheme and described it as the best alternative to the deadly cash and carry system.
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According to the Chairman of the Society of Private Medical and Dental Practitioners (SPMDP), Dr Emmanuel Harry Tawiah, who described the concept as “good”, he did not initially get the import because those who introduced the concept failed to spell out the fine details and benefits to all stakeholders.
Speaking to the Daily Graphic in an exclusive interview on the sidelines of the Ashanti Regional National Health Insurance Authority (NHIS) stakeholders’ engagement in Kumasi, he called for periodic review of basic rates to reflect current economic trends.
He noted that he and others opposed the concept because the explanation was inconsistent.
Reasons for u-turn
Citing reasons for his turnaround, Dr Tawiah said the capitation policy, which was being implemented in many parts of the world where health insurance was in place, had proved very sustainable, especially when the payment under capitation to health facilities were supposed to be made in advance.
According to Dr Tawiah, capitation had become pertinent especially when the cost of national health insurance all over the world was rising, with others becoming unsustainable.
He added that with time and further and better particulars together with the practical implementation of the capitation, the road had been made clearer although it was not without some teething problems.
These problems, he said, border on lack of periodic review of basic rate of the per capita and delay in payment.
Background
Capitation is a provider payment method in which providers are paid, typically in advance, a predetermined fixed rate to provide a defined set of services for each individual enrolled with the provider for a fixed period of time. The amount paid to the provider is irrespective of whether that person would seek care or not during the designated period.
Capitation takes care of only outpatient cases. Monies are always advanced to the health facilities before the patients seek care.
In January 2012, the NHIA initiated the pilot implementation of the capitation policy in the Ashanti Region. The aim of the study was to undertake a stakeholder analysis of the capitation pilot under Ghana’s National Health Insurance Scheme in the region to investigate the stakeholders’ position, power and interest during the piloting of the policy.
Service providers, led by Health Insurance Service Providers of Ghana (HISPAG) put up a vociferous campaign against the capitation. Others who voiced their displeasure about the use of the region for the pilot project included SMDP.
No Politics
Dr Tawiah expressed displeasure about the politicisation of the issues surrounding the capitation adding that “it is a learning process. We should be open-minded and put away politics. Health is a natural living process which should not be politicised”.
Challenges
Explaining further, Dr Tawiah expressed worry at the lack of periodic review of the rates paid to the service providers to reflect current economic issues including inflation rates, the depreciating cedi and other factors.
He also called for further education on the capitation to ensure that all the bottlenecks identified by stakeholders, especially the problems with Centralised Processing Centres (CPC) under the Ghana-Diagnostic Related Groupings (G-DRG) were ironed out to facilitate prompt payment.
Regional Director
For his part, the Ashanti Regional Director of the National Health Insurance Scheme, Mr Daniel Acheampong-Frepong, assured the stakeholders of the readiness of the authority to deal swiftly with their concerns.
He told the Daily Graphic that the capitation would be extended to three other regions this year and to the entire country subsequently.