The National Health Insurance Authority (NHIA)
had initiated moves to identify accredited private hospitals owned by medical officers who practice in nearby public hospitals to streamline their
activities including withdrawal of accreditation where necessary.
The measure followed discovery that patients who attend public hospitals were sometimes referred to the private hospitals making the National Health Insurance Scheme to pay twice for the same sickness.
This was disclosed by Dr Nicholas Tweneboah, Director of Operations at the NHIA, at a workshop organized in Koforidua for managers of the National
Health Insurance Schemes (NHIS), in the Eastern Region.
The workshop was to come up with cost containment strategies and the collection of operational data for the schemes.
Dr Tweneboah said the NHIA was also introducing the consolidation of the clinical auditing of claims to ensure that they were properly audited to help reduce cost.
Dr Tweneboah explained that under the consolidation of clinical auditing of claims, all claims from regional and teaching hospitals would no longer be audited by the schemes but would be sent to the consolidation centre in Accra.
He said those measures were being taken because during clinical auditing of many of the claims, it was discovered that the scheme was paying more money than it was supposed to due to the lack of personnel with the requisite capacity to do the clinical auditing.
Dr Tweneboah said the NHIS was also designing prescription forms that would contain the professional numbers of the prescribing officers and the dispensing officers so that such people could easily be identified.
He said plans were far advanced for a pilot project in the Ashanti Region to test the introduction of capitation on the service provision at the primary care level.