3.1.1 DUTIES OF THE GENERAL ASSEMBLY (GA)
The core responsibilities of the General Assembly are:
(1)
To
determine the mission and general policy of the scheme.
(2)
Develop Constitution of the Scheme.
(3)
Elect Management Board Members.
3.1.2 DUTIES OF THE CARETAKER COMMITTEE (CTC)
(1) To enforce the
constitution of the scheme.
(2) To appoint Scheme
Operation Management.
(3) To monitor the
financial performance of the scheme and report to the General Assembly.
3.1.3 DUTIES OF THE SCHEME OPERATIONS MANAGEMENT (SOM)
The team is responsible for;
(1)
The
day-to-day management of the scheme.
(2)
Develop a business plan.
(3)
Develop a budget for approval by the caretaker
committee.
(4)
Presents financial statements for approval by
the caretaker committee
(5)
Any other function that will be determined by
the caretaker committee from time to time.
The Scheme Operation Management is made up of:
(1)
The
Scheme Manager/Administrator
(2)
The Accountant.
(3)
The Public Relations Officer (P.R.O).
(4)
Claims Manager.
(5)
Management Information Systems Officer.
The SOM units require advice from Health Personnel on
technical matters regarding Claims manage-
ment.
3.1.4 DUTIES OF THE P.R.O.
(1) He ensures that
members within the scheme`s operational area are aware of the scheme`s Package
as far as health insurance is concern.
(2) He manages the ID
cards.
3.1.5 DUTIES OF THE M.I.S OFFICER
(1) He administers
the management information systems and makes sure that all computers of the
Scheme are functioning.
(2) He manages the
database.
(3) He supervises the
data entry clerks in their day-to-day work.
(4) He organizes in
service training for the data entery clerks where and when necessary.
(5) He is responsible
for the servicing of all computers in the system every quarter and
(6) Any other duty
that may be assigned to him by the manager.
3.1.6 DUTIES OF THE CLAIMS MANAGER
(1) He receives and
vets all claims from the scheme`s accredited Health care providers and
(2) He prepares
reports on claims and briefs management on claims.
(3) He organizes
quarterly meetings with service providers.
3.1.7 DUTIES OF THE ACCOUNTANT
(1) He receives all
moneys accrued to the scheme.
(2) He offers
financial advice to the scheme manager.
(3) He receives and
issues items into and out of the stores.
(4) He trains staff
under the accounts units as to how to keep track of financial data.
(5) He ensure the
banking of all moneys of the scheme.
3.1.8 DUTIES OF THE DATA ENTRY CLERK
(1) She/he receives
forms from registration officers.
(2) He vets and makes
entries on software.
3.1.9 DUTIES OF THE SCHEME MANAGER
He coordinates the day-to-day activities of all the units
under the scheme.
CHAPTER FOUR
4.0 ACTIVITIES
4.1 RECEIVING OF CLAIMS
This is done when the monthly claims are brought by service
providers. The number of claims forms,
total service charge, delivery (ANC/PNC), the date and the cost of drugs are
recorded in the claims register book.
4.1 VETTING OF CLAIMS
This is done by scrutinizing the claims to ensure that
clients treated are active members, correct services are charged and medicine
supplied in line with the medicine list base on the treatment guidelines.
4.2 APPROVAL OF CLAIMS:
After vetting, the number of people treated, amount submitted by the
service provided and the amount approved are recorded into a ledger book.
4.3 ORGANIZING QUARTERLY MEETINGS WITH SERVICE
PROVIDERS: This is done every quarter to
analyse and evaluate any activity regarding claims administration.
4.4 CONDUCTION OF PERIODIC VISITS TO PROVIDER SITES: This is often done to do away with all manner
of fraud if there is any.
CHAPTER FIVE
SPECIAL ISSUES:
5.1 MANNUAL AND ELECTRONIC VETTING
The scheme vets the claims in two folds; the manual vetting
and the electronic vetting. The manual vetting
is done to ensure that correct services are charged and medicine supplied in line
with the medicine list based on the treatment guidelines whereas the electronic
vetting is done to ensure that clients treated are active members.
5.2 RECORD KEEPING
The NHIS claims department keeps records in two separate
books; the claims register book in which the number of claims forms, service
charged, the date, and cost of drugs are recorded in the ledger book in which
the number of people treated, amount submitted by service providers and the
amount approved after vetting are recorded.
5.3 ANNUAL REPORT
HIS`s year is from January to December each year. At the end of each year, the claims
department prepares report on claims.
This is presented to the management for appropriate action to be taken
SUGGESTIONS TO IMPROVE THE SCHEME
To improve the quality of service and efficiency, the
following personal suggestions should be considered.
ü
Permanent officers should be delegated to the
facilities (hospital and clinics) to be at the billing
offices to monitor the entries and
prescriptions of drugs by the doctor.
This will ensure that drugs prescribed by the doctors are given to
patients.
ü
Another pick-up (car) should be acquired for
easy mobility to the communities for education,
funds mobilization and other administrative
works that will help generate more income for the scheme,
for its sustenance and smooth running.
ü
Adequate logistics such as computers and others
should be acquired to facilitate the smooth running of the scheme.
ü
A general office structure should be provided
for those who register clients at the scheme to
forestall the daily packing in-and-out of
materials and its associated problems.
CONCLUSION
The attachment has revealed a lot of information about the NHIA. The development of every nation depends largely on quality and
accessible health care of the people in the country. Since NHIS provides quality health care to
its numerous subscribers, I entreat all people in the district and the country at
large to join it for a better development of our dear nation Ghana.
During the period of attachment, it was obvious that the scheme
is faced with numerous problems, notable among these are, inadequate logistics,
inadequate motivation of staff and inadequate office accommodation.
RECOMMENDATIONS
There are numerous problems facing the NHIS as identified
during the attachment period.
It is in the light of these that the recommendations below
are given to salvage the scheme out of the wounds.
INADEQUATE LOGISTICS
First of all, logistics such as computers, communication
equipment and others should be provided by the government and other benevolent
organizations in other to offer proper and efficient services to the public.
EDUCATION
Education on the NHIS needs to be enhanced and creating
awareness to the subscribers and people and
side the scheme. The
clients should be educated on the payment of the premium and other conditions
governing the scheme.
MOTIVATION
The NHIA should try to boost the morale of its staff and
other personnel by retraining organizing refresher course, provide promotional
and welfare packages for its workers.
This will enable them contribute their quota for the development of the scheme
and the nation at large.
INSUFFICENT WORKERS
The scheme needs more workers to enable it run the administration
effectively and efficiently. This is because, there is always more work to be
done by the few staff and a lot more need to be done. The Universities should
do well to get places of attachment for its students. This will enable students relate the
theoretical aspects of their study to the work place. If the above
recommendations are taken into consideration, the problems identified will be
minimized if not completely eradicated.
KNOWLEDGE ACQUIRED
(1)
Vetting of claims forms.
(2)
Issuing receipts to clients.
(3)
Interpretational communication.
(4)
Qualities that a good leader should have.
(5)
Records keeping.
(6)
Educating people on NHIS.
(7)
Filling of registration forms.
(8)
Alertness.
(9)
Tactfulness.
(10)Filling of renewal
templates.
