Views on health managers on claims reimbursement to health facilities
Health managers’ views were sought on claims’ reimbursement and its effects on healthcare provision in the health facilities. Almost all the managers interviewed in the four facilities were not satisfied with how claims were reimbursed. That submitted claims took a long time to be paid by NHIA. Apart from the irregularity of the imbursement, it does not often cover the total amount owed/submitted. Some of their views are expressed in the following statements:
“……….. the claims reimbursement from the NHIA has been erratic. The authority does not pay according to the plan of four weeks as stated in the Act………. Reimbursement from the authority takes several months to come to hit our account. The more worrying thing is that whenever
payment is made, it does not cover all the months owed us. For now, they owe our facility over eight to ten months but if they are paying, it will cover only two or three months which is not the best for hospital management……if you go to all the regions, they will tell you the same story….. it is really affecting us in several ways……there is need for lasting solution to this problem” [Hospital Administrator].
“……….. the claims payments to health facilities continue to become worst as days go by……. as it is not regular, the payments also come in bits as part payments sometimes covering few months out of the lot owed to the facility. It’s really affecting the operations of health facilities ……… it is a general issue for the facilities in the country. It’s really affecting our ability to manage our facilities…….” (Hospital Accountant)
Effects of delayed reimbursement on healthcare delivery to clients
Healthcare managers acknowledged that the erratic nature of reimbursement affected their ability to provide standard healthcare as expected by their clients. A medical director expressed his opinion on the delayed claims reimbursement.
“…... the financial challenges are affecting our ability to provide the care required by our clients. …our situation now is like a boxer whose hands are been tied behind him and expected to fight his opponent in the ring and win the fight………... which is impossible………………. So, our situation is the same thing…. how can we provide quality or standard healthcare to our client with resources…….? This is not possible ………………. We try to do our best though……………” (Medical director).
The participants also reported that the lack of claims reimbursement affected adequate provision of healthcare to insured clients. A manager said:
“The financial challenge we are facing is also affecting our clients seriously……. they do not get the standard of quality services required from us. Sometimes we tell them to pay for some of the from their pocket or make co-payments that is when there are in stock. If the drugs are not in stock, we tell them or purchase them from outside the facility. They are always not happy when they hear this …. But there is nothing one can do……………….so that is the current situation. It’s really affecting all of us” (Medical director).
Concerning the same issue, views of the health insurance officers were not different. An insurance officer indicated:
"If the poor which the insurance was meant to protect are now made to pay for healthcare services……… then it is no more serving the purpose……….then this is the time for the insurance managers and the government to rethink on how to overcome these financial threats"
(Claims manager).
Health managers views on reasons for delayed claims reimbursement.
We explored health managers views on reasons accounting for the delay in reimbursement of claims to the health facilities. This is a statement from one of the managers:
The delay in payment is due to the inability of the NHIA to provide enough funds for payment as a result of government’s failure to advance funds to the NHIA (Hospital administrator).
The managers also attributed the delay to politics and management issues as reflected in the following statements:
“There is meddling of politics in the management of the scheme’s affairs too much….it is not the best for sustainability for the NHIS (Hospital administrator).
Views on how to address financial challenges for claims reimbursement
We sought participants views on how the current financial challenges of the NHIA can be tackled. Some participants believe that the only way to overcome the current financial challenges faced by the NHIA is to explore alternative and sustainable sources of funding by the government through the levying of special taxes on our natural resources and existing tax sources. A manager suggested:
“It is possible for the government to impose some levies from the proceeds from our natural resources such as gold, cocoa, bauxite and oil and gas to support health care in the country. If all these potential sources are available and the government is facing challenges of raising funds to finance healthcare…. it is very difficult to comprehend. The government need to explore these sources t urgently since the HHIS is in financial crisis” (Medical director).
“I think raising the proportion of the current VAT to finance healthcare will be a bad thing at all…… that source has been supportive to the government and also reliable though…..” (Hospital accountant).
Other participants have the view that the government could raise additional funds by taxing telecommunication sector services. A participant said:
“……the government can raise additional funds locally by imposing special taxes on mobile money transfers to augment healthcare funds….” (Insurance claims officer).
Other participants also think that funds could be raised from taxes on airtime. A hospital administrator indicated:
"By the government by introducing airtime tax to raise revenue to finance healthcare as done in some countries. We can also do that in Ghana. This is easy and reliable way for the government to raise more funds to support healthcare provision in the country"
Participants think that while putting financial policies in place, pragmatic financial measures also need to be put in place to ensure judicious use of the funds for their intended purposes. A participant reported:
“…………any official or individual who misapply the scheme’s funds should be fined and prosecuted to serve as a deterrent to others or else……… if we fail to do that …. we can continue to put in more funds ………… but the financial challenges will persist” (Hospital accountant)