The National Health Insurance Authority (NHIA) has met with stakeholders, including accredited health service providers under the National Health Insurance Scheme (NHIS), to discuss the rising trend of out-of-pocket payments required of members at health facilities.

Out-of-pocket expenses are payments made with your own money for medical care that are not reimbursed by insurance.

The unapproved charges, also known as co-payments, are a violation of the Act 852 statute and the NHIA's contract with accredited healthcare service providers, according to the National Health Insurance Authority (NHIA).

Chief Executive Officer of the National Health Insurance Authority, Dr. Bernard Okoe-Boye, who expressed his concerns while addressing the media in Accra, said the practice was seriously threatening to setback progress made by the scheme.

He was not happy with the fact that co-payment had assumed precedence in healthcare facilities across the country, where it was becoming the norm.

He claimed that this undermined not only the government's efforts to achieve universal health coverage as established by a law passed by Parliament in 2003, but also those of healthcare providers and consumers.

“We owe it as a duty to ourselves, our people, and posterity to ensure the success of the Scheme, a goal we have all fortunately committed to as stakeholders.

“There have been significant improvements in utilization and access to healthcare, with over 90 per cent of OPD attendance in public institutions and 70 per cent in credentialed private health institutions being members of the scheme”, Dr Okoe-Boye mentioned.

He pointed out once more that the scheme's operational changes had allowed for monthly service and claim submissions in excess of GHC 120 million.

He said, however, it was disturbing to receive daily complaints from the members of the scheme that healthcare providers had unilaterally resorted to demanding out-of-pocket payments and extra charges for services and medicines covered by the scheme.

He observed that the phenomenon was making the National Health Insurance Scheme unpopular.

“The Authority receives several cases of co-payments on a daily basis through the call centre and from the districts, and regions across the country. Every 6 out of 10 calls received at our call centre are related to co-payments, including the very unpleasant cases of NHIS members detained by some providers over extra payment demands”, he disclosed.

He also disclosed that a survey on co-payments conducted by the research directorate of the Authority revealed that the menace was pervasive across the regions and healthcare provider types with no exceptions.

“At the tertiary and secondary care levels, NHIS members are made to pay for most services, including all laboratory investigations, and about 80 per cent of medications prescribed. Whereas at the primary care level, apart from blood film for malaria, all other laboratory investigations and about 50 per cent of medications prescribed are paid for by members in addition to other services”, he revealed.

He, however, expressed worry that the practice by the healthcare providers defeated the mandate of the Authority and the Scheme, thereby negatively impacting its operations and making it unattractive to the public.

Dr. Okoe-Boye further said that the stakeholders’ engagement was a step by the Authority to engage and allow for a dispassionate deliberation on the issue and proffer long-lasting binding solutions to the menace for the betterment of the scheme towards the attainment of the universal health coverage as envisioned by the government and the people of Ghana.

The National Health Insurance Scheme was established by the government of Ghana in 2003. The program was a form of national health insurance established to provide equitable access and financial coverage for basic health care services to Ghanaians.

The Scheme, in its 19-year journey, has undergone several policy and operational reforms through stakeholder engagement and consensus building to improve efficiency, enhance the quality of healthcare, and to ensure sustainability.

Source: The Independent Ghana