Health Minister warns service providers to stop billing for NHIS – covered treatments.

To restore public confidence in the National Health Insurance Scheme (NHIS), the Ministry of Health has cautioned health service providers to desist from billing clients for services that are already covered by the program.

Co-payments, a separate fee imposed by service providers for ailments already covered by the plan, have become a significant challenge for the plan, according to the sector minister Kwaku Agyeman-Manu. He has urged service providers, in particular the Ghana Health Service (GHS), to help address the issue.

Co-payments are prohibited.

The President despises the idea of charging low-income patients out-of-pocket for medical care, he stated.

Deliveries and other maternal care are meant to be provided without charge, but some facilities are charging patients up to GHC 1,000 for the procedure, which is inappropriate.

When it happens that way, to the end-user it will look as if the scheme is not working,” he added.

Speaking to the Daily Graphic in Accra, the sector minister said co-payments created a barrier to access, and so the ministry was working to end the illegality through meaningful engagements.

“Fortunately, the government has, in recent times, been doing well with timely payments.

We have been doing frequent monthly payments in bits to ensure service providers get monies frequently.’’

“The arrears gap have been bridged over time.

Service providers are owed about four or five months as compared to the situation that persisted some years back when they were owed 12 months and beyond.

“Service providers have, therefore, no justification to indulge in co-payments.

The act amounts to extortion, and that is illegal,” he said.

The minister said the NHIS was still effective and continued to provide unfettered access to healthcare delivery.

He said the government would continue to invest in the scheme, and added that the scheme had not shown any signs of crumbling.

Contact GHS

In order to prevent the NHIS from becoming unattractive, Mr. Agyeman-Manu asked GHS managers, who make up roughly 70% of the ministry’s healthcare provider agencies.

“From the perspective of the end-users, it appears that the plan is failing as a result of the extortions.

This statement is not intended to imply that health insurance is ineffective; rather, it is a warning to the Ghana Health Service managers to use all available resources to help put an end to this criminal activity, he stated.

The minister stated that the government was making investments to strengthen the program, particularly to carry out the goal of universal health coverage, a program that aims to remove obstacles to receiving medical care.

There is no way I would ever imply that the system is ineffective as has been suggested, he said, noting the significant investments and efforts being made.

NHIA warning

Dr. Bernard Okoe-Boye, CEO of the National Health Insurance Authority (NHIA), issued a warning to facilities in January of this year to avoid co-payment plans or risk losing their accreditation.

“I am saying with confidence that the accreditation of healthcare facilities that continue to charge active NHIS patients extra fees without consequence will be cancelled very soon.

“The NHIA injects GH 120 million annually into the health sector; each health facility in the country receives an average of GH 1.5 million per month.

“So we are pumping so much into the health sector on a monthly basis, and, therefore, we demand that patients who visit the hospitals should be taken care of and not be made to pay for services covered by the NHIS,” he said.

Admitting that there were often delays in the payment of claims, Dr Okoe Boye, however, attributed the delay in the payment of claims partly to the fact that “some of the tariffs are high and unrealistic.”

In February this year, the MoH and the National Health Insurance Authority (NHIA) reviewed upward the prices of medicines and services paid to the service providers and suppliers on the health insurance scheme to prevent them from making losses or refusing to offer services. NHIS

He said that the reviews were in accordance with the National Health Insurance Act, 2012 (Act 852), explaining that they were necessary to enhance service delivery for subscribers and give providers value for money to avoid certain gaps in accessing medications and services under the scheme. NHIS

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