Dodoma, Tanzania, Dec 10, 2015 -- The National Health Insurance Fund (NHIF) has clarified on claims by some of the registered health service providers with regard to inappropriate performance at the designated facilities.
It was alleged that lack of funds with subsequent shortage of medicine supplies and medical apparatus undermined efforts by registered health service providers to offer quality services to the convenience of patients under the arrangement.
Addressing the media in Dar es Salaam recently, NHIF Acting Director General, Michael Mhando strongly refuted allegations insisting that timely payments had been honoured and those making false allegations were inclined to tarnish the image of NHIF.
"We (NHIF) deny being the source of poor services at these centres bearing in mind that improvement efforts have always been underway in support of the government to help the public to have access to better medical services," said Mhando.
Regarding payments to health service providers, he says NHIF has been providing the service to them within the legally agreed timeframe as appears in the contracts entered with the service providers.
The Acting Director General further said that the legal charge should be paid within 60 days from the time they are submitted to NHIF and such time may further decrease due to the vigilance of the respective centre to submit claims in time and with the greatest accuracy.
However, considering the efficiency and the improvement of services and in particular the use of information systems, the fund is capable of paying such demands in the shortest time. To enable service providers to be paid more quickly, NHIF has organised an electronic system in which all major hospitals paid more than 5 million have been connected to speed up the payment demanded.
"Despite all these efforts, some things have been arising including service providers particularly government agencies that have been an obstacle due to delays ," insisted Mhando.
"Many demands that have been presented to us have been plagued by massive fraud which has taken a long time in proving eligibility, including phoning patients who have received medical care," defines the director.
He goes on to explain that some providers still have been reluctant to use the electronic system although all the facilities have been provided by the NHIF where this system facilitates the verification and control fraud.
He says the claims have been presented to them with severe limitations, including the absence of useful information causing the Fund to be unable to pay since such claims are unpayable.
Efforts made by the NHIF in adaptation include enabling service providers by giving them training in their workplace, encouraging providers to submit their claims on time so that they can be paid on time.
"We remind and emphasize that the fund has the mechanism of credit of medicine, medical supplies, rehabilitation of buildings and infrastructure of ICT for the purpose of improvement of medical services in the centres whereby the amount of 10 billion shillings has been allocated for that purpose," said Mhando.
It was further revealed that for NHIF to be able to provide health services to its members, a total of 6,347 centres had been established to offer medical services countrywide where apart from the centres owned privately, public institutions and religious organisations, the fund also has registered all the centres of government from clinic level to the Muhimbili National Hospital (MNH).
The fund has a responsibility to pay such centres for the services already given to its members for a reference period while laws, rules and regulations are followed in the repayment of the funds.
"These statements constitute grounds that the NHIF is limiting the effectiveness of these centres which is not true and contains the images to bring hatred between members either citizens and their vessel which has been entrusted to treat them," says Mr Mhando.
Last week NHIF launched Call Centre and Customer Service which shall have to receive and respond to the various stakeholders which will be delivered. The centre will be open from 7:30 in the morning to ten o'clock in the evening on working days. According to NHIF DG, the service will be available free via telephone or by email.
He said the aim of the establishment of the centre is to enable the stakeholders of the fund to submit their arguments and get quick answers without disturbance. "Here we are talking about all the arguments relating to the Fund, including the terms of members, care and treatment in health facilities, Systems Information, Claims of service providers and so on," says Mhando, adding that those concerns will be answered by the centre.
Communications centre will have a major role to integrate the Fund and its stakeholders, including members, providers and the public in general. The centre also has the capacity to cater for 30 customers' phones at the same time and comprehensive facility currently 10 stations that are ready for servicing.
Each phone will receive and respond to any issue presented and if there is a need to make a follow up on a certain information, the system allows the argument to the higher character to get a response proportional to the relevant arguments.
The centre will be the first place to find information and clarification of various issues related to the service of the Fund , thus eliminating or reducing the need of members or service providers to travel to their offices to follow the services that could be accessed easily by phone or text messages.
The establishment of the centre is part of NHIF efforts to improve ways of communicating with its stakeholders in order to achieve its role of facilitating access to better medical care for its members and stakeholders in general.
The system has ability to record and to give information on all communications conducted thus simplifying monitoring points that are still not resolved and in doing so, there is no any issue that will be left unsolved.
Posted by Veronica Silva Cusi, news correspondent
Date Posted: Friday, December 11, 2015
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