The Parliament has tasked the government to seek a solution in a financial disagreement in which districts are grappling with claiming payments from services rendered in the community health insurance.
On September 28, the parliamentary Public Accounts Committee (PAC) hearing which focused on the performance of districts and hospitals attributed that existing shortfalls are attributed to poor financial reporting and bookkeeping among other lack of basic accounting skills in districts and hospitals staff.
The Office of the Auditor General’s (OAG) report shows that financial reports provided by the district hospitals are not authentic and couldn’t be trusted.
For instance, Rwf709million of hospital payment claims were rejected by insurance (general and life) companies due to billing receipts based on outdated insurance cards, overcharging services, lack of transfers and treating cases that are not priced (covered) in insurance policies.
The first set of district hospitals – Muhima, Kibagabaga, Masaka, Kibungo, and Nyagatare) which appeared before PAC said that there is a problem of errors in billing and book entries but most of the money which appears as loses come from unpaid bills and wasteful expenditures.
This has resulted in most of the district hospitals running underneath in their cash flows and meeting their requirements of treating patients of which hospital directors say it is hard to decide between treating a patient first or choosing to ensure payment.
“Some patients are brought in as emergency cases and when we try to follow up on repayment, we find that they don’t have insurance and at times lie about their details when it comes to following records,” said Dr. Marcel Uwizeye, Director General Masaka Hospital.
Another case sighted was given by Nyagatare district officials who said that they get stuck with expenses on transporting and treating expectant mothers who are brought in using the district ambulances.
“When we claim this money spent on the ambulance, RSSB tells us in its new structures that this is not covered for and refuses to pay,” said Fred Hategekimana, Nyagatare District Executive Secretary (ES).
PAC Chairman, MP Valens Muhakwa said that this is something that needs to be discussed by all sides involved and especially raising the concern to the government for consideration.
However district hospital officials couldn’t explain the motive behind poor accounting errors which appeared in the OAGs report with audits of financial statements identifying various accounting errors which affect the fairness of financial statements.
For instance there were overstated expenditure of Rwf585 million relating to prior years was recognized in the year under review in 10 District Hospitals.
OAG also showed 12 district hospitals had overstated internally generated revenue amounting to Rwf1.2 billion relating to prior periods and was recognised as revenue in the year under audit.
Other errors were in omitted receivables of Rwf276 million in the financial statements of seven (7) District hospitals, omitted liabilities to a tune of Rwf615 million in 16 district hospitals and unsupported debtors of Rwf580 million in seven (7) district hospitals.
There were also unsupported creditors, a component which involves Rwf387 million in eight (8) district hospitals.
District hospital officials argued that this was caused by lack of skills in using the Medical Registration system and reconciling it with the new Integrated Financial Management Information System (IFMIS) thus many errors but skills training have improved the situation and some staff held accountable for the losses.
Health Insurance Disagreement
The OAG said that the long outstanding receivables mainly relate to mutuelle de santé arrears that were not cleared at the time of handing over management of mutuelle de santé to RSSB in 2015.
However the Ministry of Finance (Minecofin) told PAC last week that all these arrears were cleared after a national assessment was done.
While Minecofin told parliament that all arrears were cleared, PAC heard that the ministry of health (Minisante) has refused to pay health insurance arrears of Rwf2.4billion to 22 district hospitals and 95 health centers countrywide.
The Deputy Auditor General, Patrick Habimana said that most of the districts involved still have claims of unpaid CBHI arrears in which on average each has Rwf100million in claims but with no supporting documents.
Dr. Marcel Uwizeye, Masaka Hospital Director General said that they submitted the supporting documents on costs incurred in health insurance but the money has never been transferred while some patients continued to fail to pay for services.
Officials of Kibagabaga hospital also told Parliament that besides patients failing to pay for services, some are treated with critical conditions which are not covered in the health policy, thus a reason for some of the high charges pinned on refund receipts that are mostly rejected by insurance policies.
Minisante Permanent Secretary, Zacharie Iyamuremye said that the government will need to agree on policy with RSSB to see if this can be increased in costs.
“We are in discussions with all parties, in meantime, to see this issue resolved so that an increase is done to reduce such rejection,” Iyamuremye said but agreed there is a problem in billing errors done by hospitals.
On these issues, PAC Chairman MP Muhakwa said that the government will be asked to consider revisiting and sorting out these different opinions to boost the performance of the health sector.
He further tasked all district officials to embark on a plan to recover unpaid bills in which patients were treated with no insurance.