A number of health service providers under the National Health Insurance Scheme (NHIS) have not been paid their claims for the past seven months.
The situation has been precipitated by the inability of the Ministry of Finance to release funds to the National Health Insurance Authority (NHIA) to pay the service providers timeously.
Information indicates that some health facilities whose monthly claims are outstanding have resorted to the cash-and-carry system as they have not been paid by the NHIA for the past seven months.
According to a source close to the NHIA, there had been assurances from government quarters that money would be made available by the end of this week, so that the authority could pay arrears of claims of some service providers.
The NHIA has more than 4,000 service providers across the country and pays between GH¢80 and GH¢90 million monthly claims to them.
The source explained to the Daily Graphic that the NHIA owed most health facilities from May to October 2016, while in some extreme cases it owed other facilities claims covering longer periods.
It, however, explained that those that the NHIA owed for more than three months either had problems with their claims, which were being resolved, or they did not submit the claims on time.
According to the source, facilities that the NHIA owed for a longer period had problems, citing the case of a facility which had not been paid since 2015 because it had problems with its banks.
It also mentioned a facility which had not made claims for the past 10 months because of problems with its claims system.
The NHIA, according to the source, was presently rolling out an application launched in 2016 dubbed “claim-it” and used by health providers to generate and submit claims to the NHIA.
The system implements and enforces all the necessary claims generation rules and protocols of the NHIS. All claims submitted for reimbursement are validated by the application and ensures due diligence prior to claims submission.
A visit by the Daily Graphic to some health facilities in Accra showed that although the NHIS owed them some arrears in the form of monthly claims, they were not offering cash-and-carry services but rather offering a hybrid service where clients had to buy their own medicines.
Bided by law
At the Adabraka Polyclinic, the Administrator, Mr Jonathan Welbeck, said the polyclinic did not offer cash-and-carry services because it was enjoined by law to provide services for NHIS card holders.
“Once you come to this hospital and you have the card, you will be attended to, provided we have the kind of service you seek,” he explained.
He said the NHIS owed the polyclinic arrears of nine months and that the last time it received claims was in February 2016.
Mr Welbeck said although the polyclinic had submitted all its claims, it took three months for it to receive its grant.
“We owe our suppliers because most of the medicins are bought on credit and we are normally given a 90-day period to pay off our debt. If by then we have not received the grant, our suppliers start giving us pressure and we cannot do any credit,” he said.
In an interview, a patient at the Kaneshie Polyclinic who gave her name as Naa Kwaley said she had to buy most of the drugs the doctor prescribed for her because the hospital pharmacy claimed the medicines were not available.
Another patient, Ms Evelyn Opare, also complained that she had to pay for her laboratory tests because the hospital said the tests were not covered by the NHIS.
The situation was not different at the Mamprobi Polyclinic, although the place looked less busy, with a few patients available.
A source at the NHIS office at the hospital said it had not been paid for nine months and that it received its last claim in February 2016.
He complained that suppliers of the polyclinic were always on its neck to pay its debts, knowing very well that it had to wait for the money to be released to health facilities from the NHIA.
The source made it clear that the hospital was not operating a cash-and-carry system.
Source: Daily Graphic