THE UPPER East Regional Director of the National Health Insurance Authority (NHIA), Sebastian Alagpulinsa has observed that late submission of claims by health service providers under the National Health Insurance Scheme was partly responsible for accumulation of huge arrears the authority owed providers.
In April 2018, President Akufo-Addo said the NHIS was regaining its effectiveness after he had announced that “of the GH¢1.2 billion debt we inherited, the equivalent of $300 million, we have paid, in the last 15 months, GH¢1 billion, the equivalent of $250 million.”
Meanwhile, health service providers in most parts of the country including the Upper East Region have not received payment since the beginning of this year; a major concern they have often expressed and lamented it was bringing their facilities on the knees. The situation has also led to the introduction of what government hospitals called ‘co-payment system’ – a system they illegally charged clients to pay percentages of their medical bills. Meanwhile, they still submit claims in full to the NHIS for total cost payment.
But in an interview with The Chronicle on the sidelines the 2018 mid-year performance review of NHIS in the region on Tuesday August 28, Mr. Alagpulinsa was emphatic that some of the health service providers submitted their claims to the Claims Processing Centers (CPCs) very late. He said by the time the centers were done with scrutinizing the claims and processing same for payments, it would have taken a very long time thus, leading to arrears.
Though he admitted funding the scheme by the government posed huge financial challenge which was the major cause of delay in payment, the director insisted late submission of claims also contributed largely to the delay.
“You see, some apportion the blame only on the insurance but that is not the case at times because some actually submit [claims] very late to the CPCs and the numbers are crowded there but they turn to put the blame on the insurance.” He stressed.
While further acknowledging the financial stress on the service providers as a result of the delays, Mr. Alagpulinsa said anytime payments were made, some providers received as many months as six and such providers needed to also come out and show appreciation to the government.
According to him: “Some it comes and you see providers receiving four months, five months, six months, three months, two months. But at times they need to come out and also express some level of appreciation to the insurance because it has not been all that easy to raise monies to pay these large numbers of providers.”
In his speech on the review which was on the theme: ‘Improving the financing model of the National Health Insurance Scheme: ensuring sustainability and attaining universal health coverage in Ghana by 2030’, Mr. Alagpulinsa said pooling funds through tax, insurance contributions, and government spending could spread the financial risk across the population, thus, allowing for cross subsidisation of rich to poor and healthy to the sick. He added that with an improved funding, steps could be taken towards reaching equity and development goals and also towards consolidating social inclusion.
The various district scheme managers took turns to present their reports on their activities during the period under review. Inadequate staff, inadequate means of transport, no or inadequate computers for administrative work, inadequate office accommodation, inadequate allocation of ribbons and worm out printers were challenges that cut across most of the districts.