SERVICE providers of the National Health Insurance Scheme (NHIS) are to be pre-financed to provide services to subscribers of the scheme under a programme known as the “capitation system.”
The programme was the brainchild of the National Health Insurance Authority (NHIA) with support from the World Bank.
The pilot scheme is set to take off in the Ashanti Region and would end in 2013 after which it would be replicated in the other regions of the country.
Ashanti Region was chosen as a result of its central location and heterogeneous infrastructure and culture.
At a news conference in Kumasi to introduce the programme, the Director of Research and Development at the NHIA, Mr O.B. Acheampong, said the programme was targeted at outpatient primary health care.
He said the capitation system was also expected to improve cost containment, share financial risk among scheme providers and subscribers and introduce managed competition for providers and choice for patients.
Subscribers of the NHIS, after registration with the scheme, will be made to choose their service provider and have the flexibility to change the provider after a specific period.
Mr Acheampong said the capitation system would be practised alongside other methods of provider payment mechanisms for other levels of care other than the primary level.
Currently, the methods of payment included the free-for-service system, where there is itemised charge for every service, and the diagnosis related groups, where services are grouped and the same tariff paid for cases that belong to that group.
The director stated that the scheme now pays GH¢1 million per day to service providers in claims, an increase of over 4,000 per cent of the GH¢20,000 paid in 2005.
Mr Acheampong said the reduction in claims processing time, as well as measures like checking fraud and scaling up the free maternal and indigent care programme had ignited public confidence in the scheme.
He, therefore, debunked the assertion in certain circles that the NHIS was collapsing.
“Escalating number of outpatient visits adds to the growing evidence of increasing confidence in the NHIS,” Mr Acheampong said.
He stated that between 2007 and 2009, the average outpatient claims cost increased by nearly 211 per cent.
According to him, presently outpatient claims account for 90 per cent of the total NHIS claims and 70 per cent of total claims’ expenditure.