Public and private health facilities across the country are struggling to provide basic care for patients who are card-bearing subscribers of the National Health Insurance Scheme (NHIS) due to unpaid claims by the National Health Insurance Authority (NHIA) totalling GHc420 million.
The NHIA paid claims to some service providers up to May 2015 while others were paid up to April 2015.
Service providers nationwide submit an average of GHc84 million as claims every month to the NHIA.
Based on this, outstanding claims submitted between June 2015 and January 2015 is about GHc672 million.
The law allows a 90-day grace period for processing and payment of claims; therefore, NHIA will be deemed to be in arrears of five months, which amounts to GHc420 million.
This is because the claims between June and October 2015 have exceeded the 90-day grace period for processing and payment while the claim submitted at the end of November 2015 will be due for payment at the end of this month.
The Finder can report that last Thursday officials of the Society of Private Medical and Dental Practitioners Ghana (SPMDP), Ghana Health Service (GHS), the Christian Health Association of Ghana (CHAG) and Chamber of Pharmacy, Ghana met with the NHIA Chief Executive Officer over the issues.
At the meeting, it was decided that another meeting be held this Wednesday at the offices of NHIA, and this time round representatives of teaching hospitals will join them to deliberate on how best to resolve the challenges facing the NHIA.
Sources told The Finder that the NHIA pledged to clear the arrears of June and July 2015 this month while the arrears of August and September will be paid in March.
The sources revealed that the payment would start from the Brong Ahafo Region, which has more service providers than any other region.
The Ghana Health Service (GHS) and the Christian Health Association of Ghana (CHAG) are set to renew their agreement with NHIA.
When contacted, Dr Isaac Morrison, President of the Society of Private Medical and Dental Practitioners Ghana (SPMDP), who also attended Thursday’s meeting, said every service provider is affected.
He recalled that during the Public Accounts Committee sitting recently; parliamentarians appealed to government to find money to sustain NHIS.
He is of the view that the situation is a national issue that must be discussed dispassionately to find a lasting solution to the perennial funding crisis.
A survey conducted on NHIS indicates that service providers are not happy with the scheme.
The findings indicate that 30% of service providers are not happy with delay in payment, 10% not satisfied with low tariffs, 10% not happy with co-payment, and 50% not satisfied with high-level policy issues.
The research recommended that financial sustainability, quality issues and customer care should be improved.
Meanwhile, the NHIA has reached agreement with Health Insurance Service Providers Association (HISPAG) to continue to provide services to subscribers while NHIA finds money to settle a good part of the arrears in one month.
The agreement was reached on Friday and signed by Dr Anang Adjetey, Director of Corporate Affairs, NHIA, and Frank Torblu, Executive Director of HISPAG.