LET AXE FALL (AUGUST 19, 2008)

THE National Health Insurance Scheme (NHIS) is one of the major pro-poor interventions by the government to alleviate the suffering of the people.
Health insurance schemes the world over are designed to lessen the burden of health financing on both the government and patients.
Until recently when the Ghana Heart Foundation instituted a package to cater for 50 per cent of the cost of treating hole-in-heart patients, that burden fell squarely on the shoulders of the patients or their relatives.
Thus the NHIS offers everybody the opportunity to contribute to a common fund from which those in need of health care can source funding for treatment.
Although the NHIS does not cater for all health challenges, it is a more progressive approach to affordable and accessible health care than the cash-and-carry system.
In spite of the positive attributes of the NHIS, the goings-on at the mutual health insurance schemes and the service providers, if not checked pretty soon, can precipitate the collapse of the system.
From the conception stage to date, the NHIS has faced a lot of challenges such as resistance by a section of the public, the inability of the people to pay the premiums and delay in the issuance of identity cards to premium holders, as well as the cumbersome procedure in reimbursing service providers.
These challenges have necessitated threats by some health facilities to deny premium holders healthcare services if they are not reimbursed for the services they have rendered.
The decision, therefore, by the National Health Insurance Authority (NHIA) to suspend two service providers, Atasomanso and County hospitals, both private hospitals in Kumasi, for allegedly indulging in fraudulent activities must send the right signals to all service providers that the axe will fall heavily on them if they breach the regulations.
The NHIA has further directed that the scheme manager and the accountant at the Ga District Mutual Health Insurance Scheme at Amasaman in the Greater Accra Region should step aside for thorough investigations into the operations of the scheme.
The act establishing the NHIA clothes it with so much authority to deal with financial malfeasance in order to sustain the scheme through prudent financial administration.
We do not think that the managers of the schemes are angels. They are human beings who can make genuine mistakes or indulge in all kinds of activities for personal gain, hence the need for effective supervision.
That is why the regulatory powers vested in the NHIA must be invoked at all times in order to keep all the schemes and the service providers in line with best practices.
For this reason, all the stakeholders should be made to sign up to the strict regulations of the scheme so that healthcare delivery can become accessible and affordable to all Ghanaians irrespective of their status in society.
The DAILY GRAPHIC is aware of the challenges facing health insurance schemes worldwide regarding claims by health professionals. Similar fraudulent claims threaten health insurance schemes in the UK, USA and Canada.
We, therefore, call on the NHIA to step up its oversight responsibilities in order to keep the stakeholders within the law establishing the schemes.
The DAILY GRAPHIC endorses the swift action by the NHIA, and we call on it not to hesitate to invoke the “riots act” when any of the schemes is going wayward.