The Upper East Regional Branch of the National Health Insurance Scheme has fully rolled out capitation in the 13 districts of the region.
Capitation is an alternative payment method that pre-determined fixed rate of monies paid in advanced to service providers to provide a defined set of services for each individual enrolled with the provider for a fixed period of time.
According to the regional NHIS Director Mr. Sebastian Alagpaulinsa said, effective per capita payment will be done first week of December 2016 adding that, under the capitation payment method, care is provided for emergencies and subscribers can access health care at the nearest health facility.
“However emergencies in the PPP shall be paid upfront and emergencies outside one’s PPP shall be reimbursed using Ghana Diagnostic Related Grouping [GDRG]for services and itemized billing for medicines “.
Addressing a press conference in Bolgatanga, Mr. Alagpaulinsa said, capitation will promote competition among health care providers’ and choices for patients in minimizing financial risk on the scheme .
He added that, the payment method will foster closer provider- patients relationship and further curb the imbalances associated with Ghana Diagnostic Related Grouping (GDRG) and fees for service .
“Capitation will address the three visits per illness episode by some patients resulting in gross abuse and excessive utilization of health care facilities and a threat to financial sustainability of the scheme” .
The following services are covered by capitation; OPD consultation , laboratory investigations and other services like routine maintenance care such as antenatal care and postnatal care and family planning service delivery.
