Feb 17, 2012 at 1:52pm
NHIS Capitation In Ashanti

The National Health Insurance Authority (NHIA) last month started the implementation of the Capitation on pilot basis, and the programme is expected to be rolled out to cover the entire country by the close of this year. The NHIA says it undertook 16 months nationwide public education to get the subscribers, health providers and policy makers to appreciate the need to review the reimbursement policy. The health insurance scheme was instituted to replace the cash and carry system. Available information indicates that, at the time the NHIS Bill was passed in 2003, Capitation was among the implementation alternatives suggested to make the scheme sustainable in view of the high cost involved. It was however not stated when it will come into force, but it was obvious that the capitation will definitely happen in the course of implementation.

Capitation is defined as a payment system in which all service providers are paid, in advance, a predetermined fixed rate to provide services for a given period. The amount is paid whether or not people access health care within the payment period. This system in the view of the NHIA is to check the abuse in the existing payment system by service providers leading to false payment amounting to millions of Ghana Cedis according to special audit reports. Capitation was therefore seen as an alternative means to reduce the abuse.

The Ashanti Region with a population of about five million was chosen for the pilot. The pilot programme has met fierce resistant from medical professionals including, the Ghana Medical Association, the Society of Private Medical and Dental Practitioners Association, the Physician and Laboratory Association, and lately the Ashanti Region Caucus in Parliament. There has also been demonstration by a group calling itself Asante Development Union calling for the suspension of the pilot capitation scheme and even went as far as demanding the resignation of the Chief Executive of the NHIA. While critics of the Capitation say it is a good policy,, they maintain that the public education about its implementation is not enough to ensure its success. The critics claim that the quality of health delivery has been affected because the service is only limited to provision of primary healthcare, and does not cover more drugs and diseases.

The Society of Private Medical and Dental Practitioners Association which takes care of 30 percent of healthcare delivery in the Ashanti Region withdrew from the Capitation saying, if the system is not suspended to allow for broader consultations, it could collapse their facilities. The Ghana Medical Association has also informed the Ministry of Health, the NHIA, and Parliamentary Select Committee on Health about certain issues that need to be addressed before the implementation of the policy. It is important for the officials of the NHIA to listen to these concerns and not wait for the capitation scheme to be reviewed as and when necessary. This is because healthcare is so sensitive that it cannot pass that test without losing human lives. An independent survey carried in seven private and public health facilities within three weeks into the implementation of the policy showed a disturbing trend. There is a clear indication that the nation is preparing for the deadly cash and carry system, because OPD attendance at all the facilities has reduced and in some cases below five percent. While clients who are the patients claim they do not understand the system, the health providers are also saying there is something wrong. Another disturbing feature is that, the debate over the implementation has taken political dimension, and this is not healthy in view of how dirty our politics tend to be in matters of national significance. While one political divide thought the pilot in Ashanti is a good intention to be able to roll out across the country by the beginning of next year, another party believes that it started in Ashanti with deliberate intention to make the people to resort to the old cash and carry system. What is evidently clear is that, no matter what, both have a genuine case. Nothing should prevent the policy makers to have a second look at the policy on capitation because if care is not taken the scheme is likely to backfire after being acclaimed internationally as one of the best healthcare policies in the world.

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