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09.12.2005 Health

National Health Insurance Scheme policy not baby-friendly

By GNA
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Koforidua, Dec. 9, GNA - The National Health Insurance Scheme (NHIS) has been described as being "baby unfriendly" at a meeting between the Scheme's Manager, other stakeholders and the Management of the Koforidua Government Hospital.

The managers of eight out of the 16 district-wide schemes in the Eastern Region argued that by the NHIS policy, beneficiaries were supposed to be registered with a scheme for a period before enjoying any benefit but newly-born babies had not registered with any scheme and so could not enjoy the facilities of the scheme.

The meeting was organized by the Management of the Koforidua Regional Hospital to interact with Managers of schemes that used the services of the Hospital in the Eastern Region.

While the Management of the Hospital advocated that the cost of health needs of the newly-born babies should be taken on by the Health Insurance Schemes because benefits of registered parents were supposed to be extended to their children under 18 years, the Scheme Managers thought otherwise.

The Managers further argued that under the NHIS policy, they were supposed to send figures of exempted persons to the National Health Insurance Council (NHIC) for reimbursement and since the babies might not have been born they would not have been captured in the data sent for reimbursement.

As a compromise stand, the Managers of the schemes advocated a co-payment system until the babies were registered and qualified to benefit from the scheme.

After a long debate, the Scheme Managers agreed to absorb the medical bills of newly-born babies, provided the mothers of those babies were registered and the babies were also registered with the scheme within one month form the day of their birth.

Earlier in an address, the Medical Director of the Koforidua Regional Hospital, Dr Obeng Apori, called on the NHIC to release funds early to the schemes for them to pay hospitals and clinics, which provided services to their members.

He appealed to the Council to approve the proposed standard charges of health care delivery to help to reduce arguments over the cost of health care between service providers and the managers of the schemes. Dr Apori explained that for the month of October this year, the Health Insurance Schemes provided 19.9 per cent of the total revenue realized by the Hospital for the month.

He explained that if such huge amounts of money would be held up by the schemes for a long time, it could put a stress on the resources of the hospital and could affect acquisition of supplies and the quality of care.

Dr Apori called on the managers of the schemes to inform the Management of the Hospitals on reports of illegal charges that they received from their members to help the Hospital to take measures against any medical staff who might be involved in such illegal deals. He emphasised that the NHIS had come to stay and that was the best thing that could be done for the citizens of the country and, therefore, called on employees of the scheme to contribute his or her best for its success.

The Administrator of the Hospital, Mr Lucio Derry, said some of the challenges facing the Hospital included cumbersome processing of claims, especially at the Pharmacy and Laboratory Departments. He explained that if health staff would have to spend long hours filling claims forms then there would be very little time left for their professional service and that could affect the quality of work.

Mr Derry, therefore, appealed to the schemes to help to simplify their claims forms and suggested that they engaged desk officers for the Hospital to take over the documentation process from the Hospital. The Eastern Regional Co-ordinator of NHIS, Mr George Kumi-Kyeremeh, said the Region planned to initiate a networking among the schemes in the Region such that with the same card, a registered member of a scheme from one district could access health care in another district in the Region.

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