The National Health Insurance Authority (NHIA) has adjusted upwards rates it pays health providers on the capitation pilot in the Ashanti region. The announcement was made in Kumasi on Tuesday, February 12, as the Authority met stakeholders in the region to begin review of the capitation pilot started a year ago. The review meeting brought together officials of the NHIA, Ministry of Health, Ghana Health Service and healthcare providers from the public and private sectors in the Ashanti region.

By this announcement, government facilities in the region will see their per capita rates go up by 31%. Mission health facilities received a 20% upward adjustment, while private providers get a 51% increase.

According to Sylvester A. Mensah, Chief Executive of the Authority, the revised rates approved by the Minister of Health takes effect from 1st March this year. He told stakeholders that the rates were revised due to concerns raised by providers in the region, mainly from private facilities, that the capitation rate as offered by the Authority was low.

Chief Director of the Ministry of Health, Dr Sylvester Anemana who chaired the review meeting mentioned that capitation as an additional payment method is a government policy and the ministry will provide all the needed assistance to ensure that the method is successfully rolled-out across the country by the end of the year.

Tuesday’s meeting, which commenced the capitation review process, was to provide an independent consultant the opportunity to make public his findings on all aspects of the implementation of the pilot.

The consultants, Community Partnership for Health Development (CPHD) advised the NHIA to take a gradual approach in scaling-up capitation across the country. Patrick Apoya who presented the report on behalf of the CPHD said many of the providers had problems with the capitation rate, which they described as low.

Though findings from the consultants presented positive prospects for capitation, it was mentioned that broader consultation with stakeholders should be held, which should result in further trade offs between healthcare providers and the NHIA.

According to the report, the NHIA by rolling out this payment method for general outpatient care, is likely to make the scheme more efficient and prevent abuse of the health insurance system.

Among others, the consultants remarked that in order to make the nation-wide roll-out smoother, communication between the NHIA and subscribers has to be stronger. They advised the Authority to ensure that commitment of providers was secured before the scale-up to avert some of the challenges faced in the pilot phase.

The meeting also received presentations from some of the providers and other professional groups on the way forward for the capitation payment system.

The NHIA will hold further deliberations with various stakeholders to reconcile their impressions and ideas on the way forward for the nation-wide implementation of capitation by the second quarter of the year.

Capitation is a provider payment mechanism in which providers in the payment system are paid, typically 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 would seek care or not during the designated period.

The pilot exercise was intended to generate feedback that will inform the subsequent nation-wide roll-out of the capitation payment method. The capitation payment mechanism will run side by side the Ghana Diagnosis Related Groupings (G-DRG) method.