Fallout Of NHIS Capitation Pilot In Ashanti: Lessons For A Nationwide Implementation

One of the most debated initiatives taken by the National Health Insurance Authority (NHIA) since its inception is the attempt to pilot the capitation in the Ashanti Region. The capitation which is one of the three main payment systems under the National Health Insurance Scheme (NHIS) sought to replace the fee for service which was considered to be causing a rapid rise in cost and thereby threatening the sustainability of the NHIS. The capitation is a provider payment mechanism in which providers in the payment system are paid typically in advanced and pre-determined fixed rate to provide a defined set of services for the individual enrolled for a fixed period of time. Hence, capitation was considered to have the tendency of improving the viability of NHIS, simplifying claims processing and addressing difficulties in forecasting and budgeting.

The attempt to pilot the programme in Ashanti Region was met with various stakeholders opposing the initiative, some with genuine and others with altered motives. Indeed virtually all labour fronts in the health sector of the Ashanti Region resisted the operationalization of the scheme. Some civil society groups took the opportunity to air their grievances concerning the policy. The political nature of the region gave course for diverse interpretation by various political parties since Ashanti is the world bank of the New Patriotic Party. Pundits considered it a way of punishing the inhabitants of the region but not necessarily delving into the nitty-gritty of the policy. Surely viewing everything from a political sense has affected the country tremendously and Ghanaians must live above that. The per capita payment of GH₡1.75 per month for a patient was considered woefully inadequate by service providers leading to the redrawal of service by some members of Society of Private Medical and Dental Practitioners (SMDP) in the region.

Notwithstanding the incessant pressure mounted on Mr Sylvester Mensah's outfit, the capitation pay system was implemented in the Ashanti Region. It has been over one year of the initiatives implementation in the Ashanti region and various reviews are been done. Has the implementation of capitation justified its merit? The Kumasi Metro Director of Health during the Metropolis Annual Performance Review indicated that many health facilities say the tariffs paid under the scheme remain woefully inadequate leading to poor health delivery. Again some private health facilities opted out of the scheme and few ones that are on board charge fees for services hitherto covered by the NHIS. The late disturbance of claims contrary to what capitation stood for is also disturbing. The last time some health facilities received claims was five months ago. The late release of funds led to the rundown of some health facilities especially the government owned ones. The inclusion of maternal and child health care under the capitation also raised alarm.

Though the aim of reducing cost and help sustaining the NHIS is still on course, there is still the need to pay attention to some of the issues raised above. In deed the health of the Ghanaian should not be compromised on the grounds of cost effectiveness of the scheme. It is clear that the late involvement of stakeholders in the implementation capitation was the recipe for the controversy and misunderstanding between service providers and the scheme. This definitely ought not to repeat itself as the authority aims at implementing the initiative throughout the country by the end of the year. Again the increase in the capitation rates by an average of 37 percent is welcoming but measures should be made to enhance early release of funds in order to ensure efficiency in health delivery. The exclusion of chronic and degeneration diseases as well as maternal healthcare should be reconsidered.

Capitation which is considered an efficient provider payment method is well established in most countries including Britain, Thailand, Chile and Estonia. Lessons learnt from these countries and used simultaneously with our country context happenings can help improve the National Health Insurance Scheme.

SAMUEL APPIAH ADJEI ([email protected])