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BUDGET Reveals Strides In NHIS Management
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Dr Kwabena Duffuor (seated with briefcase on lap) gets set to present the 2012 Budget
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The Minister of Finance and Economic Planning, Dr. Kwabena Duffour has in his presentation of the 2012 Budget praised highly the National Health Insurance Scheme for its performance over the course of the last few years and also dropped hints of new initiatives to further improve the Schemes operations in the coming years.

While touching on the performance of the Health sector in 2011, during the presentation of the 2012 Budget to Parliament last Thursday, November 17, 2011, the Minister of Finance and Economic Planning revealed that to ensure the sustainability of the NHIS and adequate coverage, the Ministry of Health collaborated with the Ministry of Employment and Social Welfare (MESW) and identified the very poor in society for registration under the National Health Insurance Scheme, through the Livelihood Empowerment Against Poverty (LEAP) programme.

The identification and exemption of the poor in society from premium payment, according to experts, has relieved the poor of the burden of finding money to pay premiums, resulting in extending coverage to many of the poor and vulnerable in society, which is a unique means of ensuring that quality healthcare does not become a preserve of only the rich. These measures have also been instituted to meet various national and internationally accepted objectives like the Millennium Development Goals (MDGs) of expanding healthcare coverage of the population.

Again, the 2012 budget indicated that major achievements were made in the area of claims management citing the auditing of 28,925,293 claims and the recovery of GH471,215 from services and GH755,582 from medicines in the course of the year. Greater progress was also made in clinical audit undertaken throughout the country where quality of care issues was addressed to ensure that subscribers get the quality care they require.

It would be recalled that some of the main issues which negatively affected the smooth administration of the National Health Insurance Scheme, in the past, included losses incurred from claims settlements as a result of fraud, inflation of prices of medicines supplied to subscribers, the irrational prescription of medicines, the overbilling of medicines, the provision of services above the accredited levels among many other such challenges which caused the scheme to lose huge sums of funds.

The recovery of various sums of money as indicated in the budget is therefore a step in the right direction and an indication of the prudent management initiatives instituted by the Sylvester Mensah led administration.

Mr. Mensah, earlier during the course of the year at various international conferences for health insurance managers and experts, indicated that clinical audit conducted into the scheme and various service provider facilities revealed some of the above listed constraints, which were being dealt with and the latest revelation from the Budget is an indication of the fulfillment of that promise.

Sylvester Mensah, Chief Executive Officer, NHIA
The 2012 Budget also gave the strongest indication yet of plans to make the NHIS, a one-time premium paying scheme.

Dr. Duffuor in his presentation stated that in order to accelerate the achievement of universal health coverage, Government will commence the implementation of the one-time premium payment policy under the National Health Insurance Scheme (NHIS).

The National Democratic Congress in its campaign toward the 2008 general elections promised to institute a one-time premium policy for the NHIS when elected, and has since assumption of office made strenuous efforts towards fulfilling that promise.

Again, the Finance Minister stated other measures which were being introduced to improve financial controls and further promote efficiency in the scheme. Among these measures is the piloting of Capitation as an additional Provider Payment Mechanism (PPM) and a review of the NHIS law which is expected to lead to a major restructuring of the Scheme at the district, regional and national levels.

With these refreshing developments, captured by the Minister of Finance and Economic Planning in the 2012 Budget, the National Health Insurance Scheme can be expected to operate on a sounder administrative foundation well into the future, following the implementation of these comprehensive changes being introduced under the present management.

However, with the current high and increasing membership and utilization across the country, coupled with high and increasing claims expenditure, government would have to bite the bullet and increase the NHI Levy from the current 2.5% to 3.5%, if the Scheme is to be sustainable well beyond 2013.
Source: Peacefmonline.com

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