The National Health Insurance Authority (NHIA) has suspended the capitation programme in the Ashanti region with effect from August 1, 2017.
The NHIA has said its board shall undertake a thorough review of the whole Capitation Payment Mechanism and processes and will inform the public of the way forward after the detailed review is completed.
The Senior Minister, Yaw Osafo Marfo, earlier in July 2017, announced government’s plans to suspend the programme in the region and discontinue its roll out across the country.
Dr. Adjetey Annag, the Head of Corporate Communications at the Authority, spoke to Citi News about the development and recounted that “some stakeholders in the Ashanti Region were of the opinion that the Ashanti Region was the only place where capitation was being implemented but NHIA scaled up capitation in the Upper East, Upper West and the Volta Region.”
According to him, capitation payments were on the verge of taking effect before this directive.
“In fact, a lot of preparatory work had been done. Registration onto preferred primary care providers had reached 98 percent and 100 percent in some cases which means everything was ready for capitation payments to those regions. That is the point we got and then the government directive came.”
About the capitation grant
Capitation is a provider payment mechanism in which providers in the payment system are paid in advance 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 amount paid to the provider is irrespective of whether that person would seek care or not during the designated period.
According to the NHIS, the fixed amount is typically expressed on a Per Member Per Month (PMPM) basis. Under this payment system, the member or subscriber selects a preferred primary provider (PPP) to provide all the services under the capitation basket in exchange for the capitation rate. The total capitation amount is transferred to the provider at the beginning of the service period. The amount is calculated based on the total number of members who have selected a given provider.