Akufo-Addo collapsing NHIS – Minority

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The Minority has called on the government to, as a matter of urgency, release funds to resuscitate the National Health Insurance Scheme (NHIS) which, according to the caucus is “currently at the intensive care unit (ICU).”

According to the Minority, the government has no excuse whatsoever to delay payment for such a long period because these monies are paid upfront as National Health Insurance Levies (NHIL) by every customer in the country.

The Minority says the Ministry of Finance is to be blamed wholly if the NHIS collapses.

The Minority’s concerns come after stakeholders in the health insurance sector threatened to withdraw their services while others have already withdrawn.

The Christian Health Association of Ghana (CHAG) and Health Insurance Service Providers Association (HIPSAG) are threatening to withdraw their services while the chamber of pharmacy, which provides pharmaceutical products and other medical consumables to healthcare providers under the NHIS, has withdrawn its services and indicated that any health facility owing the chamber for more than three months, could no longer enjoy its services unless payment guarantees were provided to them.

Speaking at a press conference in Accra on Friday, 28 February 2020, Mr Kwabena Mintah Akandoh, Ranking member on parliament’s health committee, called on the Akufo-Addo-led government to redeem its obligation under the law and pay the above stakeholders to prevent a collapse of the NHIS.

He also appealed to service providers who have withdrawn their services or planning to withdraw their services under the NHIS, to, “for the sake of the health of ordinary Ghanaians, rescind their decision while we request the government to honour her part of the contract with immediate effect.”

Read the full statement from the press conference below:

PRESS CONFERENCE BY MINORITY ON THE POTENTIALLY COLLAPSING TREND OF THE NATIONAL HEALTH INSURANCE ON 28TH FEBRUARY, 2020.

Ladies and Gentlemen, friends of the media, we have called you here to address you on the potentially collapsing trend of the National Health Insurance Scheme (NHIS). The challenges have become enormous such that almost all key stakeholders in the NHIS are financially bleeding and threatening to withdraw their services, whilst others have withdrawn already. Some of these stakeholders are; chamber of pharmacy, Christian Health Association of Ghana (CHAG) and Health Insurance Service Providers Association (HIPSAG), among others.

Ladies and Gentlemen, the chamber of pharmacy which provides pharmaceutical products and other medical consumables to health care providers under the NHIS have withdrawn their services and have indicated that any health facility owing them for more than 3 months could no longer enjoy their services unless payment guarantees were provided to them. This development is adversely affecting the NHIS. Usually, what any responsible government would have done is to calm the situation by assuring service providers of prompt payment and make frantic efforts to do same. However, Barimah Sarpong (PRO of NHIS) stated on 26th February 2020 in an interview with Citi FM’S eye witness news that, “In my hand is a document claiming that in 2017, NHIS released over GH?900million. In 2018, we released over GH?1billion. In 2019, we released over GH?865million and in 2020, we have released over GH?94million…. So, if we pay you this amount which makes a total of GHS2.96 billion and 40-45% is supposed to go into payment of medicines, then we should not be having this conversation”. This assertion by the PRO coupled with the president’s statement that government had cleared all debts owed the NHIS is a clear incitement of chamber of pharmacy against service providers.

Meanwhile, government is very much aware that they owe service providers for about 9 to 14 months.

Ladies and Gentlemen, CHAG is also a service provider to the NHIS. According to Deputy Executive Director of CHAG, Dr. James Duah, some facilities under CHAG have been disconnected from power by ECG. Examples of some of these facilities include; St. Mary’s hospital, Drobo in the Bono region; St Francis clinic, Saviefe in the Volta Region; Benito Menno hospital, Dompoase in the Ashanti Region and Presbyterian health centre, Enchi in the Western-North Region, among others. He also stated that, the issue of late submission of claims is no more a case to rely on to delay payment to service providers because of the introduction of the E-claims and also the strict adherence to submission timelines as provided for in the contractual agreement. Reliable information has revealed that most health facilities under CHAG have submitted claims up to January 2020 as we speak.

As if that is not enough, the above-named institutions have indicated that, they owe SSNIT, GRA and ECG due to delay in reimbursement by NHIA and this situation, they said was, much worrying. This is because, about 400 health facilities are in court for various reasons, such as failure of payment of their utility bills and inability to contribute SSNIT for their workers due to government’s failure to release NHI funds.

We request government to respect the NHIS Act 852, section 52(1) which states that “the minister responsible for finance shall within 30days after the collection of the levy caused the levy to be directly paid into the fund and furnished the minister responsible for health and the authority with evidence of the payment”.

Section 52(2) of Act 852 also provides that “the minister responsible for finance shall present to parliament every 6 months, a report on payment of levies into the NHI fund”.

SSNIT should also make prompt release of 2.5% as part of workers contributions to NHIS.

All monies due the service providers in the form of claims should be paid immediately in accordance with Act 852.

Ladies and Gentlemen, whilst major stakeholders and well-meaning Ghanaians have identified the potentially collapsed trend of the NHIS, the President, Nana Danquah Akuffo Addo on the other hand, keeps giving contrary positions on the status of the NHIS. For instance; the president stated in the SONA 2018 message that, the arrears choking the NHIS have been cleared and the health needs of the people are also being served better, which is not the case because service providers are referring to debts from 2018. In fact, Most Rev. Joseph Afrifah-Agyekum said that NHIS implementation is getting worse as he chaired the 28th World Day of the Sick and Official opening of St. Pauline clinic. According to the Bishop, NHIS owed Christian health care facilities about GH?87million covering the months of March to November, 2019, in some cases, outstanding claims span some months in 2018 with some remnant arrears from 2017 as well. He also stated that, the delay in reimbursement have worsened in the last year, revealing that it had moved from 7months to between 12 to 15 months which affects quality health care delivery.

Again, the president in SONA 2019 said on page 9, paragraph 3 “today, our NHIs is buoyant. Government has paid up the 1.2billion arrears we inherited and brought the operations of NHIS back to life”. Whilst he was referring to the NHIS as a buoyant one, there was a decline in active membership from 10.422million in 2017 to 10.410million in 2018. He further asserted that, payment of the said arrears had brought the operations of NHIS back to life. Interestingly, page 24, paragraph 7.6, item 1 of the 2017 NHIS fund formula indicated that the unpaid claim arrears amounted to GH?425.79million. The President’s assertion is not supported by any document as far as we are concerned and this is misleading. We therefore cease this opportunity to advise the President to cross-check his facts before coming public.

Ladies and Gentlemen, whilst the key stakeholders in the health insurance industry are getting financially suffocated as a result of delay in payments of claims, the President, in the 2020 SONA at page 25, Para 3, line 4, described the NHIS as operating more adequately. This is a demonstration of insensitivity to the plights of service providers and beneficiaries.

It has come to our attention that; some service providers have decided to withdraw their services from NHIS. Although, we share in their grievances, we are appealing to them for the sake of the health of ordinary Ghanaians to rescind their decision whilst we request from government to honour her part of the contract with immediate effect.

Leadership, members of the press, ladies and Gentlemen, one more important way by which the NHIS is being collapsed is the introduction of the Earmarked Funds Capping and Realignment Act 2017 (Act 947) which is applicable to NHIS. Instructively, whilst critical thinkers are of the opinion that there is the need for other viable alternative means of funding the NHIS, this insensitive government is rather busily siphoning monies in the name of capping. For example, in 2017, the NHI levy collected was GHS2,233,912,183, the amount allocated was GHS1,814,537,436 and the amount capped was GHS419,374,747. (Page 202 of 2018 budget). The capped amount could have completed some abandoned hospitals started by the NDC government or constructed over 1000 CHIPS compounds.

In 2019 also, the NHI levy collected was GHS2,381,014,749, amount allocated was GHS1,692,678,294 and the amount capped was GHS688,336,455 (page 205 of 2019 budget). The capped amount here could have also paid for the amount owed HISPAC and the Private Health Facilities Association of Ghana, which is about GHS200million.

In 2020, the budgeted NHI levy is GHS2,582,257,802, the amount to be allocated is GH?2,191,615,926 and the amount to be capped is GHS390,638,876 (page 217 of 2020 (budget).

The beneficiaries of NHIS and service providers are handicapped today because of this capping law. Capping is negatively affecting payment of claims and causing an untold hardship to the service providers.

Referring to the 2017 formula as shown in Table 1, it can be observed that between 2014 and 2016, there was a marginal increase in reported collection and a corresponding increase in the releases from the ministry of finance to NHIS.

Table 1: Reported Collection (NHIL and SSNIT) Against Releases from MOFEP

Year

Reported collections GHS

Releases GHS’m

Differences GHS’m

Differences%

2014

980.31

731.00

-249.31

-25.44

2015

1185.67

846.64

-316.06

-27.18

2016

1279.44

1101.85

-177.59

-13.88

In contrast, Table 2 shows a drastic increase in the reported collections from 2016 to 2018 and ironically shows huge decrease in the amounts released from the same period.

Table 2. Reported Collection (NHIL and SSNIT) Against Releases from MOFEP

Year

Reported collections GHS

Releases GHS’m

Differences GHS’m

Differences%

2016

1279.44

742.11

-537.33

-42.00

2017

1564.01

660.40

-903.61

-57.78

2018

1579.49

506.80

-1072.69

-67.91

Ladies and Gentlemen, we are deeply concerned at the potentially collapsed trend of the NHIS as a result of the delay in releases coupled with the drastic decrease in the releases and the capping of the fund.

Ladies and Gentlemen, government has no excuse whatsoever to delay payment for such a long period except to say that government is hoarding the money for reasons best known to them. This is because, these monies are paid upfront as NHIL by every customer in this country. The question is where is the money? The Ministry of Finance is hence to be blamed wholly for the collapse of the NHIS.

The minority hereby demands that the Akuffo Ado led government immediately redeem its obligation under the law and release funds to resuscitate the NHIS which is currently at the incentive care unit (ICU).

Thank you.

SIGNED

KWABENA MINTAH AKANDOH

(RANKING MEMBER FOR HEALTH)

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