Health insurance provider proposes co-payment of premiums
Acacia Health Insurance Company, one of four private health insurance providers registered by the National Health Insurance Authority (NHIA), has proposed that individual beneficiaries of health insurance must pay part of the premiums.
Advertisement
This, it stated, would act as a safeguard against incurring unnecessary cost by both the beneficiaries of health insurance, as well as the employers who pay the premiums and also curtail the high incidence of huge unpaid claims.
Making the proposal at a stakeholder’s forum for its clients in Accra last Wednesday, the Chief Executive Officer (CEO) of Acacia, Dr Daniel Amooh, said “if we get staff to co-pay a little, it might be as small as five per cent, eight, 15 or 25 per cent but with that little extra that they would pay for the service that they are served, I am sure we would be able to keep low the number of times that we use healthcare.”
He said the forum, which also involved the NHIA, was to brief clients on new developments since Acacia migrated from a mutual health insurance status in March 2015 and obtained a licence in May 2016 to operate as a commercial health insurance company.
Offers
Speaking on the topic “Keeping the health insurance premiums within manageable limits – The Acacia proposal,” Dr Amooh told the clients that by the end of the year they would have to choose between two offers that would be made to them.
“So what we are offering is that at the end of the year, either you would want to pay a premium for us to do the things that we are doing now or if you want us to co-pay; share a bit of the cost, we can take that part of the cost to the staff, and that would be a discount to how much we pay as the premium.”
Explaining the need for co-payment of health insurance premiums, he stated; “If we want to keep to the barest minimum how much we pay at the end of the year for our staff we need to get them to start funding a bit of the bill.t.
“When you know that you have to foot the bill every time you go to the hospital, you would actually ask – do I really need this service? Is there a way that I could shift this to a month or two months?”
Quoting the findings of a research known as the Rand study conducted in the USA from 1974 to 1988 for three groups of persons, Dr Amooh said it showed that those offered free healthcare visited the hospital at a rate of 4.45 times each year, those who had to pay a fourth of the bill went to the hospital 3.33 times, while those who had to pay so much for their healthcare went to the hospital less times and spent less.
He also stressed that healthcare should be given to those who needed it most.
To Dr Amooh, there was also a huge gap in healthcare between those who needed the service and those who offered the service and because of that huge gap, those who offered the service were the ones who drove healthcare service.
Credentialed Schemes
The Director, Private Health Insurance Department (PHID) and Secretary to the NHIA Board, Mrs Diana Oye Ahene, who spoke on “The Private Mutual Health Insurance Reforms in Ghana”, cautioned the public to be wary of all those who paraded themselves as health insurance schemes.
“Care must be taken when dealing with schemes that are not credentialed. We are unable to help subscribers who work with unlicensed schemes because they are illegal. Ask if the scheme has a licence before working with them,” she advised.
Mrs Ahene said there were some schemes that had not been licenced by the NHIA but were still operating and investigations were ongoing into their operations and asked clients to ascertain relevant information on schemes from the NHIA website.
“Three companies like that are being investigated for prosecution. Some others have their licences pending and their time has been extended to November 2016 so that their clients do not suffer but they have been asked not to sign on new clients,” she told the forum.
On payment of claims issues, Mrs Ahene said that as an agreement was the first step in resolving such issues between the providers and clients there should always be a signed agreement before any dealings began.
