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THE failure of mutual health insurance schemes in the Kumasi metropolis to pay claims to health service providers in their catchment area is seriously undermining quality healthcare delivery in Kumasi.
According to the Kumasi Metropolitan Director of Health Services, Dr Kwasi Yeboah-Awudzi, mutual health insurance schemes in the metropolis had not paid claims to accredited hospitals and pharmacy shops since May 2009, making it difficult for the health service providers to generate the requisite revenue to replenish drugs and other medical suppliers needed to enhance quality service delivery.
However, the Ashanti Regional Manager of the NHIS, Mr Afrifa Yamoa Ponko, disputed the assertion that claims had not been paid since May 2009.
Dr Yeboah-Awudzi said at the moment, the schemes owed about GH¢4,574,571 to some hospitals and clinics in the Kumasi metropolis and its environs.
Expressing concern on the situation in an interview with the Daily Graphic, Dr Yeboah-Awudzi said, “Hospitals in Kumasi are not only running out of consumables and drugs and their managements are also being constantly harassed by those who supply them medical consumables to run the hospitals.”
He said in December 2009, medical superintendents in the metropolis wrote to him complaining bitterly about the undue delay in paying claims and appealed to the government to intervene as a matter of urgency.
He said in their letter, the medical superintendents pointed out that “if no significant payment of claims is made as early as possible, quality service delivery will become seriously affected”.
Dr Yeboah-Awudzi said as of December 2009, about GH¢4,574,571 was owed some accredited hospitals and clinics in Kumasi
He pointed out that the Manhyia, Suntreso, Kumasi South, Tafo and SDA hospitals, as well as the Kumasi Children’s Hospital, the KMA Clinic and the Apatrapa Clinic, were the worst affected.
Giving details of the situation, Dr Yeboah-Awudzi said as of December 2009, the scheme owed the Manhyia Hospital as much as GH¢1,059,983, with GH¢1,006,696 owed the Kumasi South Hospital.
He said the scheme also owed the Suntreso Hospital about GH¢800,000 and the Tafo Hospital about GH¢600,000.
“It also owes the SDA Hospital GH¢849,079, the Kumasi Children’s Hospital GH¢218,614, the Apatrapa Clinic GH¢14,000 and the KMA Clinic about GH¢30,789,” he explained further.
Dr Yeboah-Awudzi said the failure of the scheme to pay claims to the accredited health service providers “has also affected payment to Medical Stores that supply drugs and consumables to us”.
He said since hospitals in the Kumasi metropolis and its environs had not paid the GH¢2 million they owed Medical Stores in the region, “they have cut all supplies of drugs and consumables to the hospitals and this is seriously undermining our operations”.
“Apart from the non-payment of claims to hospitals, the scheme also does not pay claims regularly to some accredited pharmacy shops in the metropolis so they also refuse to give the requisite drugs to members of the scheme who present prescriptions, thus undermining quality healthcare delivery,” he bemoaned.
When contacted, Mr Yamoa Ponko disputed the assertion that claims had not been paid since May 2009.
Explaining, he said since he took over the administration of the scheme in the region about four months ago, some payments had been made to enhance the operations of healthcare providers .
“We have reimbursed the mutual health insurance scheme for prompt payment, but we always vet the claims to avoid all fraudulent claims and this sometimes delays the payment,” he said.
Mr Yamoa Ponko said the Kumasi South Hospital, for instance, was paid GH¢24,729.55 about three months ago, while the Suntreso Hospital was paid GH¢159,632.62.
He said the Manhyia Hospital was also paid GH¢29,434.34 moments after he had taken office, while the Tafo Hospital was paid GH¢10,616 for the claims submitted.
He said the SDA Hospital was also paid GH¢354,177.60, with the Apatrapa and the KMA clinics being paid GH¢7,394 and GH¢11,896.36, respectively.
He gave assurance that his administration would continue to collaborate with the service providers to enable them to offer quality health care to their clients in the region.
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