Upper East Regional Manager of the National Health Insurance Scheme Sebastian Alagpulinsa says it is a breach of contract and violation of terms of agreement for the scheme providers to charge subscribers with valid health insurance cards fees for services rendered.
Some health facilities including the Bolgatanga regional hospital charge national health insurance subscribers additional fees even though they are valid card holders of the scheme. This decision according to the hospital is part of contingency plans to augment the deficit that is often created when claims are paid. Medical director of the hospital Dr. Peter Baffour intimated that the decision to charge subscribers is as a result of insufficient payments often made by the scheme to the facility which turns out to be less than what the facility owes its suppliers. It therefore became necessary for the facility to initiate measures that will enable it supplement what it gets from the scheme to pay debts owed suppliers.
“It is better we charge the people to pay something so that we can pay our suppliers and have enough stock than continue giving everything out and at the end of the day we leave an empty store. It is a situation we are not happy about but that is the only way we can keep the facility running” he said.
But in an exclusive interview with A1 Radio’s Azongo Albert, Upper East regional manager of the National Health Insurance Scheme Sebastian Alagpulinsa said it is a violation of the terms of agreement that exist between the scheme and providers and that NHIA does not endorse co-payment.
Mr. Sebastian Alagpulinsa conceded that his attention has been drawn to the matter and a meeting has since been held with management of the hospital for redress.
“NHIA does not condone co-payment and so if you look at our contract form on cost containment guidelines point 7 says if the provider agrees to adhere to our standard of practice and to avoid the accreditation being taken from the provider, there should be no co-payment. So what it means is that any provider who engages in that is contrary to our practice and that provider’s accreditation can be taken away. So we held a meeting and they gave their side of the story and we also explained to them our position. So clearly I cannot have this contract signed with you and ask you to still take money. Clearly that practice is not in conformity with our principles” he noted.
He added that the shortfall in payment of claims is as a result of an incidental delay in tariff review of the scheme stressing that very soon the new tariffs will be out which will resolve the issue of the shortfall.
Source: Albert Azongo | A1radioonline.com | Ghana
