Private health providers in Dar es Salaam complain of delayed NHIF payments
What you need to know:
- They claim that money deducted by the fund has led to some centers failing to continue with business to serve the people. Therefore, there is a need for the government to review the fund so that the claims of service providers can be paid.
Dar es Salaam. Private health facilities in Dar es Salaam are facing challenges due to the delay in payment of claims issued by the National Health Insurance Fund (NHIF).
According to the Association of Private Health Facilities (APHFTA) Dar es Salaam Zone, which serves the regions of Lindi, Mtwara, and Coast, investors have the responsibility to provide better services to the community, and the government, through NHIF, should do its part.
"The fund is everything," said the Zone chairman, Dr. Lazaro Wambura. "They are the players and judge, and whereby they can pay claims as they wish. Sometimes they can reduce the money that the service provider has used to serve its members. We wish to see the process of universal health insurance ended so that this fund can be regulated."
Mr. Wambura added that the money deducted by the fund has led to some centers failing to continue with business to serve the people. Therefore, there is a need for the government to review the fund so that the claims of service providers can be paid.
NHIF Claims Processing manager Dr. Raphael Mallaba said that the claims are paid after all the verification steps are over. Therefore, other service providers are getting paid late due to various reasons.
"Regarding on financial deductions," he said, "if we are not satisfied with the level of claims, that action should be followed, but the service provider has the right to file complaint to the reconciliation unit and if we are satisfied, will be refunded."
Dr. Malaba added that the government is in the process of establishing universal health insurance. "We have been cry for the fund to be under the regulator, which means that the health packages will not be for NHIF alone but for all insurers."
Speaking at the event, Dar es Salaam Regional Medical Officer Dr. Rashid Mfaume said that the region has 1336 health centers, of which 86 percent were owned by the private sector.
He added that the government must continue to create a friendly and enabling environment for service providers, because the government alone cannot serve all citizens.
"As we continue to create enabling environment we emphasize these service providers is to focus on the provision of quality services to the citizens as it is the priority of the government as well as observe the ethics of the health sector," he said.
Meanwhile, health facility owner and board member of the association, Ms. Rehema Msami, said that there are challenges for private service providers, such as too many fees and taxes.
"We would wish to see all taxes deducted together but at the moment each institution comes and takes its own fee so it becomes a challenge for us," she said.
On the part of NHIF, "We have been receiving challenges from our members but some of claims are not basic, so not every challenge belongs to NHIF," said one official. "Others are caused by our members."
