Three more regions to operate NHIA capitation policy
The National Health Insurance Authority (NHIA) has decided to add three more regions to its capitation policy. They are the Upper East, Upper West and the Volta regions.
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This follows the successes chalked up by the NHIA in the Ashanti Region, after a three-year piloting of the policy.
The capitation scheme is a payment method under the National Health Insurance Scheme (NHIS) in which a pre-determined rate is paid to health providers by the NHIA to provide a specific service to card bearing individuals of the NHIS.
Workshop
The Business Systems Manager of the NHIS, Mr Joseph Annor, announced this at a sensitisation workshop organised by SEND Ghana, a non-governmental organisation (NGO) in Accra last Thursday during which officials of the authority educated some selected health providers and non-governmental organisations on the capitation scheme.
Mr Annor, who is also a member of the capitation team of the NHIA, added that currently, sensitisation and educational programmes were being rolled out, especially in the three regions, to explain how the scheme worked.
He debunked claims that the capitation scheme was a form of punishment targeting certain group of people in the country, explaining that it was rather an enhanced form of simplifying claims processes by health providers.
Difference between NHIS and capitation policy
Mr Annor explained that under the capitation scheme, the NHIA would pre-pay 22 per cent of the total cost of services to be provided by the health providers at the Out-Patient Department (OPD) for NHIS card bearers.
He said the remaining 78 per cent resulting from services rendered by the service providers would then be forwarded to the NHIA for processing and reimbursement.
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The NHIA official further indicated that unlike previously where the NHIA waited for the month to end before the service providers furnished it with their expenditure, “this time, we are advancing 22 per cent of the amount to be paid at the end of the month for the providers even before they offer the services.”
The PPP
According to Mr Annor, under the capitation, an NHIS card bearer was entitled to a health provider, popularly referred to as the PPP, and was at liberty to change the provider after six months if its services were not satisfactory.
“The selection of the service provider is strictly left to the NHIS card bearer to determine which health facility to access the service. We do not determine which health provider a client should go to,” he explained.
Background
Giving the background, Mr Annor said the country established the NHIS in 2003 through the enactment of Act 650 to secure the provision of basic healthcare services to persons resident in the country.
“Since the implementation of NHIS in 2004, the Fee-For-Service (FFS) has been used for the payment of medicines and some other services until 2008 when the Ghana Diagnostic-Related Groups (G-DRGs) was introduced to pay providers on the basis of claims made by them to the District Mutual Health Insurance Scheme (DMHIS).
“In January 2012, the NHIA initiated the pilot implementation of the capitation policy in the Ashanti Region and after three years of piloting, we think it is time to extend it to other regions,” he explained.
The Programme Officer of SEND-Ghana, Mrs Harriet Nuamah-Agyemang, was hopeful that participants were enlightened enough to be able to explain what capitation in NHIS meant.
Writer’s Email: severious.dery@graphic.com.gh