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NHIS suspends capitation in Ashanti Region

NHIS suspends capitation in Ashanti Region

The National Health Insurance Authority (NHIA) has suspended the capitation programme of the National Health Insurance Scheme (NHIS) in the Ashanti Region.

The suspension which takes effect from August 1, 2017 follows a directive from government.

A statement released on Tuesday and issued by the Corporate Affairs Directorate of the NHIA said the Board of Directors of the Authority would undertake a thorough review of the whole capitation payment mechanism and processes.

It added that the public would be informed of the way forward after the detailed review is completed.

Read also: Govt to abolish NHIS capitation in Ashanti

Capitation, which is one of the most effective and efficient healthcare provider payment systems, was implemented on a pilot basis in 2012 in the Ashanti Region. The scheme initially faced stiff opposition and challenges from healthcare providers in the region.

The opposition faced, was due to lack of adequate education and sensitisation to the project in the region, a challenge that made the National Health Insurance Authority (NHIA) to learn lessons from the pilot programme.

After the pilot, real implementation began in the Ashanti Region  and the extension of the programme to the Volta, Upper East and Upper West regions brought  to four, the number of regions implementing the new provider payment method.

Under capitation, service providers are paid in advance, a pre-determined fixed rate to provide a defined set of services for each individual enrolled with the provider for a fixed period of time.

The amount paid to the provider is irrespective of whether that person will seek care or not during the designated period and it covers only primary health care for out-patient attendance.

One advantage of capitation, is that it guaranteed the service provider a certain amount of money at the start of every month depending on the number of subscribers enrolled in that facility.

The pre-payment of claims under capitation, according to the NHIA, was, therefore, an incentive which made it easier for service providers to forecast and plan their activities without worrying about delays in claims reimbursement from the NHIA.

 

 

 

 

 

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