Healthcare Providers Sabotaging NHIS

The National Health Insurance Scheme (NHIS) has come under severe criticism by the opposition New Patriotic Party (NPP) in particular. In the estimation of the NPP, the scheme has ‘collapsed’. Analyst and government officials have put up defence for the scheme insisting that if the scheme as so described to have collapsed would still have people being registered onto it including even members of the NPP. Some of these analysts and NPP commentators or relatives also rely on the NHIS for medical attention and their experience at the various health facilities they may have visited certainly could have formed the basis of their analysis. So they may not be entirely wrong in their conclusion. 

Accessing healthcare with the NHIS card comes with some technical challenges especially with regards to where a patient is receiving healthcare falls under primary, secondary or tertiary status. If you are NHIS card holder, you can’t access direct healthcare in hospitals referred to as tertiary hospitals. What it means is that you must have been referred from a primary healthcare provider to be able to access healthcare in those facilities. Apart from that, there are also issues of misconceptions about the use of the NHIS card. What is clear and must be put on record is that, the same NHI policy applies to all health facilities irrespective of whether or not they are private or public. In other words, there is no special policy under the NHIS for private health facilities as opposed to public ones. So irrespective of where you’re receiving healthcare, the policy is absolutely the same.

In an interview on Joy 99.7fm on November 17, two gentlemen recounted what their spouses went through as they tried to receive healthcare using the NHIS card. In that interview, the two gentlemen have had to pay virtually for all the services including even those covered under the health insurance for some funny reasons. Their experience is not new as it was similar to what I went through when my wife delivered in a private hospital in 2012. While I managed to save myself some huge money I could have paid but for my insistence that the right thing be done, a poor lady was detained by the facility because she could not afford the delivery fees as I was told. All these experiences are enough reasons for people to come to the conclusion that the NHIS has ‘collapsed’ while I call it sabotage by healthcare providers. The Communications Manager of the NHIA in the same interview bemoaned the failure on the part of ‘victims’ to register their complaints at the district offices of the NHIS for action to be taken against defaulting health facilities. He even asked the interviewer to furnish him with details of the gentlemen for investigation.

But the Communications Manager’s call begs the following question: how many people will be bold to report issues like this? In any case how many NHIS subscribers are aware of this procedure? And more importantly, is the scheme in position to ensure that those who report issues like this would be protected and not victimized by nurses at the defaulting facilities? More so, how can a patient tell the services and drugs that he/she is being made to pay for have been covered under the NHIS? These are strong question that demand convincing answers. Unfortunately, the majority of NHIS subscribers who are already poor and cannot afford quality healthcare, are either driven away or made to cough up money to pay for what they are supposed to receive free of charge. Meanwhile, I was reliable told some officials at the NHIS district offices have become philanthropists paying premiums and membership renewals for those who visit their offices with the complaint that they could not afford those fees.

Quite recently, my mom was admitted at a public hospital for a week. Her NHIS card had expired two months earlier and had not been renewed before her admission. As it were, we paid for all the services she received. When her membership card was renewed two days later, we brought it to the hospital in the hope that we would receive services covered under NHIS free of charge. In spite of that, we were still had to pay for some items for which no receipts were issued. I demanded receipt but was told no such thing was supposed to be issued to me. I decided not to make any fuss about it because my priority was to have my mom given all the medical attention she required.

A couple of days later, I met a pregnant woman and out of curiosity decided to interact with her. In the cause of that brief interaction, it came out that she has been paying for all the antenatal care she has been receiving from a private hospital. I asked her if she has the NHIS card and she answered in the affirmative. She said she was told the health insurance scheme covers only part of the cost while she has to pay up the difference even though her membership is active. I requested to see the receipt for the payments she has made so far and she gladly showed them to me. She added that there are some services she paid for, for example antenatal booklet, but was not given any receipt and when she demanded receipt, she was told to go see the authorities of the hospital before a receipt would be issued to her.

It’s a common knowledge how the staff of some of these health facilities behave. They consider everyone to be stupid except them and therefore if you approach them to find out why NHIS card holders are being charged for the services covered under the health insurance, they wouldn’t mind you at all. So I went straight to the district office of the NHIS to make a complaint on behalf of the lady with her details. In fact I didn’t meet the district manager but I met a staff whose position I don’t know and didn’t bother to ask so long as she willingly granted me an audience. She asked me if the pregnant woman actually brought her issue to the attention of the NHIS officer attached to the health facility to handle such issues and my response was absolute no even though I have no idea the NHIS has attached some officers to health facilities to handle suspicious claims. In fact, right in front of me, she called their rep there and gave her the details as I have provided and instructed her to investigate and report back to her the next day. She then told me to come back in two days.

I later told the pregnant woman what I had done and it was clear she was uncomfortable. This stems from the fear that she might suffer victimization at that facility but I told her no such thing would happen because there is no wrong doing on her part even I didn’t reveal her identity.

On the second day, I returned to the district NHIS official. In her office, she told me her investigation confirmed my claim. But was quick to add that, in order to avoid a situation where the pregnant woman would be maltreated at that facility, she suggested that I should let go off the case unless of course the pregnant lady is prepared to change the facility. According to her, the administrator of the facility explained that the antenatal booklet, for example, was sold to them by the District Health Authority (DHA) therefore the facility was left with no choice to sell it to its clients. Then I pointed it out to her that if the allegation by the administrator of the facility that the booklets were sold to them, why should they have difficulty issuing receipts after selling same to their clients? Well this question was more of a rhetorical one because the NHIS official does not work with the DHA. I have tried to make contact with the DHA without success.