The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

NEARLY six million dollars was paid to healthcare providers enrolled in the National Health Insurance programme from April 2017, its inception, to June 2018, a new report says.

Tabled in the House of Assembly yesterday, the report, the first of its kind for the NHI Authority, said there were 35,731 beneficiaries and 37 healthcare providers up to June 30, 2018, the end of the period covered by auditor Baker Tilly Gomez.

Up to December 13, 2018, NHIA officials said there were 45,821 people enrolled and 51 providers.

Providers are paid through three mechanisms: fees for services, capitation and bundles.

“Fees for services are recognised based on the covered services at rates established by the authority and are paid retroactively based on the volume and nature of the patient services provided,” the report said.

“Capitation is a payment arrangement for health care service providers. NHI pays physicians a set amount for each person assigned to them, per year, but paid in monthly instalments while the patient remains registered with the physician, whether or not the person seeks care. The amount of remuneration is based on the average expected health care utilisation of the patient, then adjusted to risk associated with each patient. NHI pays a base amount of $150 per patient per year which is then adjusted for patient gender, age and location.

“Bundles are packages of care that involve multiple physician visits with associated other care costs that are combined and paid for together. NHI has two bundles, maternal care and infant care. Maternal care bundles are adjusted for case complexity. Infant care covers the child from 0-24 months and includes immunizations.”

The auditor said the authority “manages its capital to ensure the entity will be able to continue as a going concern.” At the end of the period covered by the report, NHIA had an accumulated fund of $5.3 million.

NHIA is seeking an “IT solution project including database hosting, platform hosting and all other related IT system development work,” the report noted. In the fiscal period considered, the authority spent $164,802 on computer software development.

Enrolees currently receive only primary care coverage through the NHIA. Cabinet recently asked NHIA to revisit its plan that would significantly expand the cost of the programme and the services available.