Gaming the National Health Insurance Scheme already?

Tolon, (N/R), Nov. 27, Ghanadot/GNA- There has been a high rate of attendance at health facilities in the Tolon/kumbungu District since the introduction of the National Health Insurance Scheme (NHIS) and the situation has become a matter of concern and if not addressed could become a major challenge to the scheme in the near future.

The number of card bearing members who used their cards to access health from health facilities in the district from January to September 2008 was 35,752 with a total of GH˘ 506,567.60 bills paid to the accredited health facilities.

Mr. Issah Sulemana, Scheme Manager for the Tolon/Kumbungu District Mutual Health Insurance Scheme (TKDMHIS) expressed this concern at the joint launching and first Annual General Meeting of the Scheme in Tolon on Thursday.

A 10-member management Board with Mr. James Abdulai as Chairman was later sworn into office.

He said the total registered members of the scheme as at October 31 this year stood at 111,547, representing 82 percent of the district population of 135,083, while ID cards printed and issued for clients during the same period were 74,781 being 55 percent of the district.

Mr. Sulemana said the target for this year was to increase registered members from 52 percent (71,422) of the district population at the end of 2007 to 70 percent (94,558) by the end of 2008.

The target for ID cards produced and issued to members was to increase from 24 percent (32,916) of the district population from the beginning of the year to 40 percent (54,033) by December 31, 2008.

He said however that, the scheme exceeded its target as at the end of October this year and that the registered membership rose from 52 percent (71,422) to 82 percent (111,547) of the district population and ID cards issued increased from 24 percent (32,916) to 55 percent (74,781) of the population.

Mr. Sulemana said the scheme since its inception had been able to pay all legitimate claims submitted by various accredited health facilities within the stipulated time.

He said the scheme this year received a total of GH˘ 513,225.40 as premium from the National Health Authority (NHIA) for the exempt group and paid GH˘ 506,567.60 as claims to providers as at September.

He said the scheme also received GH˘ 20, 000 as administrative support from the Authority and they had also been paying the salaries of the six permanent staff since the year 2004.

Mr. Sulemana said last year the scheme received one Hilux Toyota pick up, one jailing -125 motorbike, two phoenix bicycles and four computers adding that this year they received a state of the art stand by generator.

Talking on the challenges facing the scheme in the district, the Scheme Manager said they lacked accommodation and were temporary using the Tolon Town Council.

He said the high poverty level and illiteracy rate were also a hindrance to the smooth operation of the scheme, saying that out of the111, 547 registered members, 36,766 of them were not able to pay for their premium and registration fees as a result they were not able to get their cards.

Mrs. Denisig Kaara, District Director of Health said since the inception of the Mutual Health Insurance Scheme, health facilities in the district had received more clients than before as well as an increase in revenue.

She said Out of Patience Attendance (OPD) had increased from 24,859 in 2005 to 31,737 in 2006 and about 32,156 in 2007.

She said, in addition, clients no longer abscond with unpaid bills due to inability to pay the cost of health services.

Mr. Wahab Suhiyini Wumbei, District Chief Executive called on the Board Members to address complains of unnecessary attendance to hospital, sick people waiting until they were on admission before they came for cards and service providers over-charging for services rendered to clients.

Mr. James Abdulai, Board Chairman of the Scheme said the TKMHIS was the second best in terms of national rating.

GNA