Members of the Private Healthcare Providers Association together with Health Insurance Service Providers Association of Ghana have threatened to withdraw some National Health Insurance Scheme (NHIS) services from 1 March 2020 over the government's failure to pay outstanding debts owed them.

According to the associations, the Ghana Revenue Authority, ECG and SSNIT, have been dragging their members to court because they are unable to pay the SSNIT contributions of their staff and tariffs to state institutions. 

Speaking at a press conference in Accra, on Monday, 17 February 2020, Executive Director of Health Insurance Service Providers Association of Ghana, Mr Frank Torblu, said the government must support NHIS to discharge its core mandate.

He said: “We’re very much aware that the Finance Minister made a profound statement that the collection of 2.5% National Health Insurance levy on behalf of NHIA would be sent to their account directly. We want to know if that is the current arrangement, why then our claims cannot be paid on time? It has become unequivocal that the inability of the NHIA is caused by the Finance Ministry. We request that the Finance Minister takes the necessary steps to transfer whatever is due the NHIS”.

Failure to do this, Mr Torblu advised the public and NHIS card holders to carry cash alongside their cards to meet the cost of any service that they may not be able to provide immediately when visiting health facilities.

Below is his full statement to the press:

PRESS STATEMENT BY PRIVATE HEALTH FACILITIES ASSOCIATION OF GHANA [PHFAOG] AND HEALTH INSURANCE SERVICE PROVIDERS ASSOCIATION OF GHANA [HISPAG] ON 17TH FEBRUARY, 2020

Good morning,

Ladies and gentlemen, friends of the media and all protocols observed.

The leadership of HISPAG and PHFAOG wish to express their sincere gratitude for the tremendous and unflinching support in articulating our views, grievance, and concerns to the various authorities for redress.

We would like to draw the attention of the good people of Ghana that a progressive nation is the one that its leadership takes prudent and pragmatic steps to adequately invest in the health of its people by providing the necessary infrastructure, the logistics and human resources to manage them.

The private sector augments the public sector very well in the provision of quality healthcare services to the people of Ghana over the years.

The primary objective of this press conference is to put the records right regarding the NHIS indebtedness to the providers.

DELAY IN REIMBURSEMENT:

Ladies and gentlemen, the core mandate of NHIA is to pay claims but this has been defeated by consistent issue of government’s inability to adequately fund the NHIS for onward reimbursement to health service providers to enable them provide quality healthcare services to the people of Ghana.

To clarify this point, NHIS owe service providers between 9 (nine) to 14 (fourteen) months which covers arrears from 2018 for some providers and 2019 for others. This is unacceptable considering the fact that, the health sector is regarded as an essential service and a key component for socio-economic development.

The persistent narrative that service providers are unable to timely submit claims as the cause of the delay in reimbursement is untenable as the scheme has enforced strict time lines for submissions stated in the contract.

The contractual agreement explicitly and categorically states; “the NHIA will make payments within ninety (90) days of receipt of claim unless written notice of a dispute or discrepancy is furnished the provider within thirty (30) days of receipt of claim.”

COURT ACTIONS AGAINST MEMBERS BY SOCIAL SECURITY AND NATIONAL INSURANCE TRUST AND GHANA REVENUE AUTHORITY.

Ladies and gentlemen, it is very sad for our clinicians to put their lives at risk to save lives of National Health Insurance card holders for which payment has not been received from NHIS but to be put before court for nonpayment of PAYE and SSNIT contribution on behalf of their staff.

What is so intriguing is that the staff and officials from these institutions who are prosecuting our members continue to receive medical attention from our facilities nationwide.

Fellow Ghanaians, there is a saying that if you cry for the chicken, you must cry for the hawk too.

We wish to send a signal to these institutions and prosecutors to be mindful of their actions. This is because if we also decide irrespective of our professional oaths to meet their action with equal and opposite reaction, the ramification may be very detrimental not only to them as individuals, institutions but also to the state as a whole.

UNREALISTIC TARIFFS:

The pricing regime should at all times reflect the market variables, it is therefore subject to review annually. The most recent being July of 2018 rather saw a further dip in pricing due to a tax waiver policy on imported and locally manufactured drugs to keep prices low but this move unfortunately was a debacle. The current medicines list is obsolete and ineffective as prices have witnessed a sharp increase by almost 80% due to prevailing economic factors.

A few illustrations to buttress the point;

1.            Amoxicillin+Clavulanic Acid Tablet 625mg: market price is GHS25.00 whiles the scheme pays GHS13.00

2.            Amoxicillin+Clavulanic Acid Tablet 1000mg: market price is GHS37.00 whiles the scheme pays GHS19.32

3.            Salbutamol Inhaler: market price is GHS25.00 whiles the scheme pays GHS12.60

4.            Clindamycin Injection: market price is GHS15.88 whiles the scheme pays GHS 9.66

5.            Cefuroxime Tablet 250mg: market price is GHS25.00 whiles the scheme pays GHS12.00

Several agitations and calls to correct the anomaly have proven futile.

PROVIDERS DEMAND.

Ladies and gentlemen the healthcare providers demand:

1.            Full reimbursement to all private healthcare service providers up to September 2019

2.            Comprehensive reimbursement plan by the NHIA after deliberation with the Private Health Facilities Association of Ghana (PHFAoG) and Health Insurance Service Providers Association of Ghana (HISPAG)

3.            An immediate review and adjustment to the medicine tariff for an effective drug dispensation.

4.            The Finance Ministry should as a matter of agency transfer all monies due NHIA in connection with 2.5% National Health Insurance Levy.

5.            SSNIT should transfer 2.5% as part of workers contribution to NHIA.

6.            Ghana Revenue Authority [GRA] should account for the total amount received on behalf of NHIA.

POLITICAL INTERFERENCE.

We have persistently asked the political actors to stay away from NHIS to enable the appointed executives and other technocrats to prudently manage the affairs of the Scheme.

It is very sad for a Minister of State to openly make an emphatic pronouncement that the NHIS owe the providers only three months.

We, therefore, respectfully advise that anybody who wants to make any public pronouncement should confer from the NHIS to ascertain the true indebtedness of National Health Insurance Scheme to the providers to avoid creating needless tension between the providers and the pharmaceutical services providers.

This pronouncement has created a situation for the Chamber of Pharmacy to cut supply of medicine and other medical consumables to our member hospitals, clinics and maternity homes nationwide. 

Meanwhile, the technocrats on the job can confirm that the Scheme owes the providers an average of nine months and every necessary   effort are being made to pay the amount involved.

TRANSFER TO NATIONAL HEALTH INSURANCE SCHEME

We are very much aware that the Finance Minister made a profound statement that the collection 2.5% National Health Insurance levy on behalf of NHIA would be sent to their account directly.

We want to know if that is the current arrangement, why then our claims cannot be paid on time.

It has become unequivocal that the inability of the NHIA is caused by the Finance Ministry.

We request that the Finance Minister takes the necessary steps to transfer whatever is due the NHIS

POLICY DIRECTION.

Deep-throat information available to us is suggesting that there is an ongoing discussion to make only public hospitals to serve National Health Insurance cardholders nationwide, a situation similar to Private Senior High Schools under the free Senior High School programme.

We pray that what we are hearing is not true. The gains made by the National Health Insurance Scheme over the years would be eroded and its purpose of establishment would also be defeated if indeed such a policy direction is finally implemented.

Health Insurance Scheme as we are all aware is the biggest social intervention policy of the state which is to ensure that every Ghanaian have equal access to quality healthcare services at an affordable cost.  The primary focus and the beneficiaries are the vulnerable and the poor in our society.

It would be a disaster on the part of anyone individual or group of persons to revert the county back by this action.

Since we cannot substantiate this position strongly, we would like government to demonstrate its commitment by making sure that the providers in the private sector are paid their claims timely and regularly. There is a saying that every chitchat has some element of truth. In view of this, the only thing that can clear our doubt is regular payment of claims and effective collaboration with the providers.

IMMEDIATE ACTION BY PROVIDERS.

Ladies and Gentlemen, effective 1st March, 2020, the providers would be compelled to withdraw some service that continues to create financial burden especially those that are not within our control.

TO ALL NHIS CARDHOLDERS

We respectfully advise the public and NHIS cardholders to carry cash alongside their cards to meet the cost of any service that we may not be able to provide immediately.

We urge Government, the Minister of Health, the NHIA and all stakeholders to treat these issues with the utmost urgency it deserves to pre-empt any imminent action by service providers.

Thank you all.

Samuel Boakye Donkor                              Frank Torblu