Milking NHIS dry and bankrupt

Introduction The malfeasance, corruption and maladministration bedeviling the operations of the National Health Insurance Scheme (NHIS) continue unabated. The technique adopted by some health officials is hurting the NHIS’ finances so badly and leaking away millions of new Ghana Cedis to line up pockets of these nation wreckers. In fact the very survival of the scheme is under threat and public especially the over eleven million subscribers’ confidence in the scheme is seriously dinted. Abuse and Naked Corruption This time the culprits are not the NHIS administrators but health officials. According to information received from a reliable source in the Brong Ahafo Region the new method being employed by the officials are milking the NHIS bankrupt and if not checked immediately, would result in its imminent doom. Field monitors discovered in the Nkoranza District (paradoxically it is where NHIS started in Ghana) that the review system and types of health problems were being inflated thrice. A member of the Field Monitoring team sent out to verify returns by the health centres told yours truly that there were unusually high review cases which aroused suspicions. No figures were provided but the numbers involved were quite substantial. Upon “ground truthing” missions to the residences of the subscribers/patients in question, it established an abuse by healthcare providers. What was being done was that officials surreptitiously recorded three visits by NHIS subscribers. The audit found that the abuse was based on the principle that each subscriber is allowed up to two reviews after initial visit to a health care provider. Many subscribers were fully cured after the initial visits and never went back for a follow up. Sensing a loophole, some providers recorded themselves review visits on subscribers cards with the intention of creaming away the difference derived from their claims. Another aspect of the malfeasance being perpetuated has to do with the type of illnesses reported to health centres. Nkoranza being predominantly peasant farming district, health centres reported so many panga cuts or 'accidents' as health incidents. Further follow ups to the subscribers/patients again failed to reveal any scars or even explicit admission of any kind of medical treatment over last six months or more. Most of the subscribers are said to have expressed shock at the news of their injury and 'strange' visits to hospitals for treatment. Measures Armed with this fact, the Nkoranza District Mutual Insurance Scheme instituted investigations at the affected health centres where the culprits have since been expelled. The scheme also refused to pay review and panga cuts visits claims. Recommendations · “Ground thruthing” exercise should be extended to cover the whole country with extended mandate · The culprits identified including those found by the Auditor General’s report for the period January 2005 to September 2005"and dismissed should be prosecuted to serve as deterrent to would-be perpetuators. [CJA charged government to act on NHIS Report]. · Administrators of NHIS should consider Health Maintenance Organization (HMO) to incorporate all current public and preventive medicine approaches such as immunizations, maternal and child health into an active health promotion effort. · A Medical Intelligence Unit should be established to assess the national health and predict emerging disease patterns, yearly physical examinations for the detection of early silent disease like hypertension, diabetes and cancer. [PNC to review implementation of NHIS] · There must be rigorous and unscheduled audits of claims and payments made on and by NHIS to keep stakeholders confident and certain future of the scheme. · The drug list should be published at the point of delivery especially within the public health institutions to allow subscribers the opportunity to satisfy themselves whether prescriptions are on the exempt or not. · Procurement procedure should not just be followed by closely monitored as it is well known across the globe that is a major source of leakage in many institutions where figures are either under or overstated. [Billions Looted At NHIS]