Deep throat sources within the NHIA and the Society of Private Medical and Dental Practitioners have indicated that the two parties are ready to sit and broker a deal over the misunderstanding that arose out of the implementation of the NHIS capitation exercise in the Ashanti Region. Signals picked up in the Ashanti region indicates that members of the Society of Private Medical and Dental Practitioners have not carried out their threat not to participate in a pilot Capitation exercise which is being implemented in the region under the National Health Insurance Scheme. Last week the group said its members would not offer services to patients based on conditions set out under the Capitation programme, pointing out that there were too many restrictions on drugs for their clients in the region as compared to other regions. It said instead, members of the group will continue to serve clients based on existing contract with the National Health Insurance Authority (NHIA). However, latest developments indicate that the group would fully get involved in the capitation exercise after reaching an agreement with the NHIA. This paper has learnt about a meeting which scheduled for Tuesday, January 10,2012in Kumasi, between the leadership of SPMDP and the NHIA, will seek to iron out their differences and afford the parties opportunity to come out with a common position on conditions that are acceptable to both parties to pave the way for a full take off of the Capitation programme. NHIS Capitation which took off on 1st January 2012 in the Ashanti Region among other objectives is expected to strengthen the referral system, improve the quality of healthcare delivery through provider-subscriber bonding, ensure advance payment of claims to service providers, and improve financial sustainability of the scheme. The introduction of the programme followed detection of abuse by subscribers and providers during audits carried out across the country in NHIS accredited health facilities. Some of the abuses included among others, facility shopping (situation where subscribers jump from one health facility to another within a matter of days). A practice the NHIA says threatens the sustainability of the NHIS. Since capitation ties a subscriber down to one service provider for at least six months, it would eliminate the situation where a subscriber could visit three different service providers within a short period of time (sometimes as short as a day or two) and obtain three different sets of medicines or services for the same condition. This is a waste of resources and of the time of healthcare personnel. The practice renders disjointed care and also puts the client at risk from the dangers of multiple medications. Described as an attempt to democratize healthcare delivery in the country, under the capitation each NHIS subscriber would voluntarily indicate their preferred primary-care provider (PPP). The preferred primary care service provider takes on the responsibility of managing the primary healthcare needs of the clients (including assisting them to adopt better lifestyles and other preventive measures to stay healthy). On a monthly basis an agreed amount of money would be advanced to the selected PPP on behalf of the client to provide for the agreed primary health care needs. It is expected that under capitation portability will be maintained. Every six months a subscriber could switch from one provider to another and payments will be redirected accordingly. The start of the NHIS capitation pilot in the Ashanti region follows over 18 months of preparations and engagements with stakeholders in the health sector. According to the NHIA, all essential triggers necessary for the commencement of NHIS capitation have been put in place. It said it has transferred funds to the schemes for payment to providers for all outstanding claims up to the end of October 2011. Also, the Authority has transferred the January 2012 per capita amounts in advance to service providers in the Ashanti Region. Capitation aside, the current management of the NHIA has introduced other key initiatives aimed at reforming the NHIS such as the setting up of a Consolidated Premium Account, Establishment of a Consolidated Claims Management Centre, requirement for a Payment Plan before the disbursement of funds, introduction of a standardized NHIS Prescription Form, streamlining of procedures for registration under the Free Maternal Care programme. Other reforms include disaccreditation of all private healthcare facilities run by full-time operatives in public health facilities to eliminate conflicts of interest and double billing of the NHIA for services to patients.