All subscribers to the National Health Insurance Scheme (NHIS) will now have to purchase medicines prescribed for them with cash or procure the consumables outside of health facilities.
This is because the Ghana Health Service (GHS), Christian Health Association of Ghana (CHAG), the Society of Private Medical and Dental Practitioners (SPMDP) and the Ghana Registered Midwives Association (GRMA) have resolved not to supply NHIS card holders with medicine anymore due to huge indebtedness.
Latest figures indicate that the National Health Insurance Authority (NHIA) is indebted to service providers to the tune GH¢553 million for a period of five months.
This decision was contained in a letter jointly signed by the leaders of the four institutions addressed to the Chief Executive Officer (CEO) of NHIA and copied to the Minister of Health, Chairman of Ghana Health Service Council, all Regional Directors of Health Service, Chief Executive Officer of the Chamber of Pharmacy Ghana and the Chairman of Parliamentary Select Committee on Health.
The letter, dated March 10, 2015, said the four institutions had resolved to run an efficient health system as stipulated by their mandates, but due to over seven months’ indebtedness of the NHIA to all healthcare providers, health institutions are unable to maintain the basic quality of care required of them.
“Heath institutions lack the necessary medical and surgical supplies because pharmaceutical companies have refused to supply medicines and other consumables on credit. The leadership of the GHS, CHAG, SPMDP and GRMA feel embarrassed by this development,” the letter said.
The letter revealed that health institutions are being dragged to court by statutory bodies such as the Social Security and National Insurance Trust (SSNIT) and the Ghana Revenue Authority (GRA) for their inability to redeem their obligations to them.
Banks have also dragged health institutions to court for overdue loans, it said.
“We wish, on behalf of GHS, CHAG, SPMDP and GRMA, to inform the National Health Insurance Council that the GHS, CHAG, SPMDP and GRMA facilities are unable to credit medicines and other consumables from pharmaceutical companies for insured clients for fear of lawsuits against them,” the letter warned.
To this end, the four institutions said they have entered into a public-private partnership agreements with many health facilities to ensure a continuous revolving of essential medicines and other consumables.
“This will guarantee the provision of emergency services and avoid mortalities or referrals for the reason of shortage of commodities.
“All clients will, therefore, be at liberty to access the facility’s revolving consumables stock or procure the consumables outside of the facility. In all cases, receipts should be secured for services,” it said.
According to them, this has become necessary to forestall further collapse of health institutions due to mounting debts that have seen a number of facilities dragged to court to compel them to pay back loans (principal with penalty) for their indebtedness to suppliers of medicines and consumables.
“We will, however, stand by the NHIA to demand the immediate release of funds from the National Health Insurance Fund since over 90% of our clients are NHIA card bearers in line with our commitment to achieving universal health coverage,” the service providers stated.
The letter said the facilities must be able to hold three months of tracer consumables, have well-maintained and functioning equipment, update the skills of their staff regularly, pay outsourced services and provide 24-hour utility services.
“Again, all facilities shall hold enough liquidity to enable them maintain the facility and prevent total collapse or be tempted into ‘alleged’ fraudulent deals for claims reimbursement,” it said.
The way forward
The leadership of GHS, CHAG, SPMDP and GRMA proposed permanent solution to the chronic delays in NHIA claims payment.
The service providers want NHIA benefit package to be restricted to only primary health care services (preventive, promotion and curative care up to the district level).
Private insurance companies or a second-tier NHIS may be used for secondary and tertiary services.
It will be better to achieve 100% NHIA enrolment with primary care services (with about 70% service package) than 38% NHIA enrolment service package, which is unsustainable.
They further proposed that subscribers pay cash for services rendered to them under the public-private partnership concept, for which service providers shall issue official receipts to subscribers to enable them submit their claims to NHIA offices for refund.
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