A report on the Pharmaceutical Society of Ghana/BUSAC Advocacy Project, has noted that Capitation of the National Health Insurance Scheme (NHIS) could be an option for financing health care if all the stakeholders were involved.

The 67-page document said the stakeholders should have been engaged in the designing and implementation of the scheme.

It said the full engagement and involvement of private health practitioners especially, community pharmacy practitioners, would ensure the success of the well intended capitation programme.

The study was aimed at mainstreaming pharmaceutical practice for a national comprehensive health care delivery system.

In 2010, the National Health Insurance Authority (NHIA) in Ghana proposed a capitation system of financing primary care and began a pilot phase in the Ashanti Region in January 2012.

Under the Capitation scheme, a hospital gets a capitation premium for a period to take care of the medical needs of a specified group of people.

Capitation payments are used to manage care organisations to control health care costs.

The scheme considers issues such as age, race, sex, type of employment, and geographical location, as these factors typically influence the cost of providing care such as preventive, diagnostic and treatment services, injections, immunisations, and medications administered in the office and outpatient laboratory tests done, either in the office or at a designated laboratory.

It also includes health education and counselling services performed in the office and routine vision and hearing screening.

The report focused mainly on a study of the challenges facing Community Pharmacy Practice (CPP) in Ghana under the NHIS.

The study covered Greater Accra Region, representing the southern sector, Ashanti Region, for the middle sector and Northern, Upper East and Upper West regions, representing the Northern sector.

The respondents were selected from NHIS clients and accredited community pharmacies. 2,400 clients and 170 providers were interviewed in the three sectors.

The document studied the NHIS, problems facing the CPP, delays in provider claims reimbursement, decreasing prescription turn-over, the proposed capitation system, the relevance of the problem and justification of an advocacy action, and data analysis.

It also assessed the veracity of the problems associated with the NHIS and how it is affecting accredited community pharmacies in meeting the pharmaceutical care needs of clients.

It determined the effect of the delays in claims reimbursement on NHIS accredited pharmacies and clients, explored clients’ preferences for separating prescribing and dispensing as a means to improve quality of care under the NHIA.

The study recommended that although the level of awareness of the NHIS is high, there is still the need for the NHIA to engage in education about the scheme especially the right of patients to exercise an option of being served at a National Health Insurance (NHI) facility, or going to an accredited community pharmacy to be served.

“This singular act by the NHIA will help provide a level playing field for both the public and private sector participants in the pharmaceutical care services delivery in Ghana,” it said.

It said the NHIA should develop more innovative ways of reimbursing accredited service providers, which should involve “designing an on-line submission of claims so as to reduce claim reimbursement time and therefore prevent capital lock up and consequent increasing cost of capital to the private pharmaceutical service providers”.

“The NHIA in collaboration with the Ministry of Health and the Ghana Health Service as well as the Teaching Hospitals should engage stakeholders including accredited community pharmacies even as the programme of capitation is being piloted in the Ashanti Region.

“Such an engagement will discuss any implementation-related challenges of capitation as a health care financing option in Ghana and take on board the concerns of accredited community pharmacies.”

The report said: “The practice of NHI facilities prescribing and dispensing at the same facility is not in tune with international best practice.”

It said though the practice appears to be a likeable option in terms of convenience to patients, there are obvious disadvantages, which if not mainstreamed could pose a serious challenge to the delivery of quality pharmaceutical care in Ghana.

The National Health Insurance Act 650 was passed into law in 2003 to secure the provision of basic healthcare services to persons resident in Ghana through mutual and private health insurance schemes.

The goal was to ensure equitable and universal access to healthcare for Ghanaians. The scheme is, however, faced with a lot of challenges, which include delays in issuance of identity cards to registered members, renewal of membership, and reimbursement to service providers.

Of great concern is the decreased prescription turnover in accredited community pharmacies across the country, posing a threat to the existence of some community pharmacies and access to quality pharmaceutical service.

“Furthermore, community pharmacists believe that the proposed capitation system of funding and amendment of the NHIA law to increase the claim reimbursement period from four to 12 weeks, will not only affect the sustainability of their practice but also compromise pharmaceutical services to their NHIS clients,” the document said.

The study assessed the impact of the NHIS on the performance of NHI accredited community pharmacies in meeting the pharmaceutical care needs of insured patients and the sustainability of community pharmacy practice.

The key findings concluded that the impact of NHIS on accredited Community Pharmacies prescription turnover was negative.

A customer satisfaction survey showed that accredited community pharmacies were unable to provide patients the full range of medicines prescribed.

Most respondents think that the future of accredited community pharmacies would be bright if the delay in reimbursement of claims could be addressed, and the NHIA could develop more innovative ways of reimbursing accredited pharmaceutical service providers.

The study quoted a report by SEND-Ghana, a non-governmental organisation, which said: “The implementation of the National Health Insurance Scheme has led to significant increase in attendance to health facilities without a corresponding improvement in health infrastructure, equipment and human resource.”

The expected high demand for pharmaceutical services by patients with the implementation of the NHIS, brought a financial demand on accredited community pharmacy practitioners.

This demand arose from the need to increase stock and create more space in facilities.

“Loans secured to meet these financial demands had a time line and it was going to be serviced from profits made from increasing sales.”

“The result of this is that patients are disappointed because they do not receive all medicines on their prescriptions or are turned away because the provider is refusing them service,” the study said.**