The National Health Insurance Scheme (NHIS) will this year introduce biometric identity cards which will be issued instantly at the point of registration to subscribers.
It would also start work on piloting electronic claims (E-claims) processing and host an extended stakeholder review of the capitation pilot in the Ashanti Region to inform its improvement and the subsequent nationwide rollout of this provider payment method.
The Chief Executive of the National Health Insurance Authority (NHIA), Mr Sylvester A. Mensah, disclosed this when he addressed members of the core management team of the NHIS and some key stakeholders at a management retreat held at Elmina in the Central Region.
Mr Mensah noted that although remarkable progress had been made in meeting targets, there was the need to consolidate those achievements and make the scheme more efficient, adding that 2013 would be a busy year for the authority.
He said the NHIA intended to establish three more claims processing centres in the Northern, Central and Ashanti regions, to complement the centre in Accra. This, he maintains, would complete efficiency measures into claims management nationwide.
Among other numerous initiatives, Mr Mensah disclosed that the scheme would be re-branded consistent with the new law, new vision and mission and operational architecture of the NHIS, adding that the financial manual of the NHIA would also be reviewed to place greater responsibility on the centre to prevent the abuse and fraud occurring at the regional and scheme levels.
Others are: a permanent and joint clinical and claims audit team would be established to undertake forensic claims audit across the country all-year round to track isolated cases of connivance between schemes and providers.
Mr Mensah mentioned that subscriber satisfaction was a key performance indicator for the NHIA, therefore, a subscribers’ handbook detailing the benefit package, medicines and subscriber rights and obligations would be compiled and made available to all subscribers at the point of registration and membership renewal.
In order to further educate the public on the operations of the scheme, Mr Mensah said a quarterly NHIS policy dialogue forum to be beamed live on television stations would be instituted.
Also, the NHIS medicines list/pricing would be reviewed to reflect market realities.
He further said the authority would begin modernising and transiting from an ICT concept, “which places more emphasis on infrastructure, to a management information system (MIS) which places premium on generating information for management decision-making”.
Among a litany of achievements recorded in 2012, he cited the passage of the new law, NHIA 2012, Act 852, the upward review of provider Tariffs by 26 per cent, creation of the condition to accommodate family planning in the NHIS benefit package, development of a consolidated premium account, the pilot of capitation in the Ashanti Region, the establishment of an operational call centre and functional clinical audit division.
Mr Mensah told the management team that “posterity will not forgive us if, in nurturing this infant institution, it slips into structural, operational, and financial inefficiency”.
The President of the Ghana Medical Association (GMA), Dr Kwabena Opoku-Adusei, who was present at the event, pledged his association’s commitment to the NHIS.
He gave an assurance that the GMA would continue to be a strong ally of the NHIS and would collaborate with the authority on the rollout of capitation across the country, if all their concerns were addressed.
He said the GMA would continue to constructively criticise the NHIA to ensure that the scheme stands the test of time.
Other participants and contributors included a former Health Minister, Dr Richard Anane, under whose watch the law which established the NHIS was passed in 2003 (Act 650), and other foreign delegations.
Source: Daily Graphic