The National Health Insurance Scheme (NHIS) has proposed a 20 percent upward tariff adjustment this year for service providers, after three years without an increment.
The Chief Executive Officer (CEO) of the National Health Insurance Authority (NHIA), Dr. Samuel Annor, told the Daily Graphic that the proposal was subject to negotiations with service providers and subsequent approval by the Ministry of Health.
There are currently more than 4,300 service providers on the NHIS’ list, out of which Community-based Health Planning Services (CHPS) compounds have 2,320 facilities.
“We believe that the 20 percent is workable within our budget. But we have to get the necessary approval from them (service providers),” Dr. Annor said.
He said the review was supposed to happen yearly, “so if it doesn’t happen, the onus is not only on the NHIS; the health providers can call us about it because we are all working together in the interest of patients. If we all sit quietly, then it means we are all happy.”
Dr Annor stated this after a stakeholders’ meeting with service providers in Accra yesterday.
The meeting was to address pertinent issues that affected the efficiency and sustainability of the NHIS.
The tariff represents fees paid to service providers per visit to an NHIS-accredited facility.
The review is done annually to reflect price changes in the market.
Dr. Annor said when the discussions were concluded, the tariff increment would take effect from January this year.
Asked whether he expected a higher percentage increment from the service providers, given that there had been no increment in the last three years, he said: “That is why we are here to negotiate. But we will negotiate within our budget.”
According to some of the service providers, they were seeking between a 25 and 50 percent increment to reflect market realities.
They said a realization of the increment would come as a major relief because of the increasing cost of health care in the country.
The Deputy Chief Executive of the NHIA in charge of Operations, Dr Lydia Dsane-Selby, said the authority, in a facility audit last year, found some anomalies in some facilities that included poor record keeping, improper documentation, inadequate professional staff, unqualified staff as prescribers in facilities, improper diagnosis to make patients seem sicker, as well as treating malaria without evidence of testing.
She said there were also many cases of service providers who were deliberately encouraging patients to come for multiple visits, with its attendant irrational prescription of medicines, laboratory requests and improper diagnosis, just to attract higher tariffs.
Dr. Dsane-Selby also described as worrying a trend in which 99 percent of claims received by the authority were nine months older, with accompanying letters to explain the delays also coming in late.