Private Health Facilities Association of Ghana says its members would no longer serve subscribers of the National Health Insurance Scheme, effective December 16.

The Association would now revert to the “cash and carry” system due to several reasons including delay in paying them for services rendered under the health insurance scheme.

“Most recent reimbursement covered the month of February, 2019 and even that, about only 30% of the facilities have received payment leaving a huge unsettled gap of nine (9) to ten (10) months which is a flagrant contravention of the National Health Insurance ACT 852 and the L.I 1809 sections 37 and 38 respectively,” it said in a statement.

After listing its challenges, the Association’s statement signed by the Acting President, Mr Samuel Boakye Donkor said:

“With these revelations in sight, we are initiating a full scale “CASH AND CARRY” on the 16th of December, 2019 if payments outstanding from 2018 to some of our members and that of 2019 is not cleared to alleviate the intensity of our woes and distress. We know this action will most likely spark an unnecessary uproar and erode confidence in policy execution by government but we have no option.”

Below is the full statement

Quality health care delivery reverberates the socio-economic policies of every government and for this reason, private health facilities in Ghana have consistently played a pivotal role in the achievement of the Sustainable Development Goal 3 through the provision of accessibility and coverage health care services irrespective of social status, gender, ethnicity and race which transcends geographical barriers to the good people of Ghana hence, our imperative contribution should not be undermined.

Majority of private health facilities in Ghana are accredited to the National Health Insurance Scheme which is a historical intervention intended to provide relief and improve the health needs of all Ghanaians especially the under privileged. We the private health facilities have been a very strong and committed partner in ensuring the intents and purposes for which the scheme was established and have done that unflinchingly over the years.

Recent developments clearly outlined below threaten the achievements and integrity of the relationship between the National Health Insurance Accredited facilities on one hand and the Scheme on another which requires prompt attention.

  • DELAY IN REIMBURSING: We have particularly resonated this subject countlessly with the hope of a permanent redress. Most recent reimbursement covered the month of February, 2019 and even that, about only 30% of the facilities have received payment leaving a huge unsettled gap of nine (9) to ten (10) months which is a flagrant contravention of the National Health Insurance ACT 852 and the L.I 1809 sections 37 and 38 respectively. Private facilities are overburdened with debt from suppliers, banks (loans and overdrafts), inability to settle mandatory payments to GRA and SSNIT. Prosecutions and constant harassments have become a disincentive to operate.

Unequivocally stated in the contract agreement: “The NHIA will make payments within ninety (90) days of receipt of a claim unless written notice of a dispute or discrepancy is furnished the provider within thirty (30) days of the claim”. We would appreciate strict adherence.

  • REVIEW OF MEDICINE TARIFF: Technically, service providers have not benefited from an upward review since 2015. The consequent removal of the 17.5% VAT on imported medicines led to a 30% price cut on medicine tariffs sanctioned by the NHIA and effected on the 1st of July, 2018. This move by the government was miscalculated and woefully failed to provide the intended effect. The situation is exacerbated with the 45% to 70% price increase by wholesalers/suppliers, far beyond the Scheme’s approved prices.

A few illustrations will clarify the point:

  1. Amoxicillin + Clavulanic Acid (625mg) is wholesaled at GH21.00, the NHIS pays GH13.02
  2. Artemether +Lumefantrine 20/120 is wholesaled at GH4.80, the NHIS pays GH2.38
  3. Salbutamol Inhaler is wholesaled at GH23.00, the NHIS pays GH12.60

Heavy losses are incurred which defeats operational efficiency.

Reference to the National Health Insurance ACT 852 sections 34,36,37 and 101 suggests an annual price review to reflect current and realistic market pricing of medicines.

With these revelations in sight, we are initiating a full scale “CASH AND CARRY” on the 16th of December, 2019 if payments outstanding from 2018 to some of our members and that of 2019 is not cleared to alleviate the intensity of our woes and distress. We know this action will most likely spark an unnecessary uproar and erode confidence in policy execution by government but we have no option.

We humbly call on the Government to swiftly intervene to avert the possible effects of these disturbing matters.

In all sincerity, we hope to receive the quickest response.

Mr Samuel Boakye Donkor

Acting President (PHFAoG)

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