NHIA settles concerns on capitation

According to him, the Service Providers had given the Authority up to Tuesday to submit the names of their representatives to the Pilot Review Committee to be set up, adding that there would be another meeting next week Thursday which would make the Committee operational.

Speaking in an interview on Oman FM's National Agenda Morning Show, Mr. Sylvester Mensah, the Chief Executive of the National Health Insurance Authority indicated that his meeting with the Service Providers, held on Tuesday, went very well and led to various concessions by both the Authority and the Service Providers on the way forward for the Implementation of the Capitation Scheme.

Mr. Sylvester Mensah, described as highly successful and very engaging, the stakeholders meeting held in Kumasi between the NHIA and Service Providers of the scheme which mainly discussed matters concerning the newly introduced capitation scheme being piloted in the Ashanti Region which has generated some level of controversy and various discussions.

In detailing the outcome of the meeting, he announced that the Service Providers proposed that more members selected by the Service Providers should be included in the National Health Insurance's Monitoring and Evaluation Team to oversee the effectiveness of the Capitation Scheme and the whole National Health System. He stated that since there was no justifiable cause for disagreement, the Authority accepted this proposal.

Mr. Mensah said that among others, the Service Providers also suggested that education on the Capitation scheme be intensified as that had caused a lot of misinformation and

misrepresentation on the operation of the scheme within the populace, the media and even the stakeholders operating the system.

Another concern expressed widely at the meeting was the need for increases in general operation costs as a result of the implementation of the Single Spine Salary Structure and the increases in fuel among other factors to be reflected in the tariffs charged by the Service Providers.  Mr. Mensah indicated that the Authority pledged to look into this particular request and concern and make the necessary reviews to the tariffs.

Finally, Mr. Mensah stated that the Authority had agreed with the Service Providers that ante-natal and post-natal care would be taken out of the Capitation scheme, something which has been welcomed by the various stakeholders.

On whether the Service Providers who had decided to opt out of the Health Insurance Scheme as a result of the introduction of the Capitation Payment Scheme had given any indication of rejoining, the Chief Executive stated that the Service Providers had not given any notice of that as yet.

He added that three options were discussed at the Meeting regarding the implementation of the Capitation Scheme and that the accepted option was that, the Scheme would continue to run but that the Service Providers would keep records of payments accruing from the past system in order to enable them compare appropriately the efficiency and benefits of running the two systems.

When quizzed on what could have happened during the long consultation process before the scheme was rolled out to cause the difficulties which had arisen especially bearing in mind that it appeared a single meeting had resolved so many of the difficulties, Mr. Mensah retorted that in his view it could have been as a result of the fact that many of the stakeholders were not too interested and concerned about the incoming scheme at the time of the consultation or probably assumed that the scheme would never be implemented and thus didn't raise the concerns being raised now.

He noted that on the part of the Authority, they were prepared, ready and willing to engage all concerned to streamline not only the Capitation Scheme but indeed the whole Health Insurance System, adding that due to the careful and long drawn consultation process undertaken, the implementation of the Capitation system was postponed on five different occasions.

On the Court action instituted by the Pharmacy Council against the National Health Insurance Authority, Mr. Mensah indicated that the Authority had received the writ and added that since the Pharmacy Council had decided on that course of action, the Authority was also prepared to go on that line.

He declined further comments on the issue, aside indicating that the writ was with the lawyers of the Authority, who were studying it for an appropriate response.