The National Health Insurance Authority (NHIA) has paid its health-care providers over GHC471 million in a spate of 42 days (24 May to 7 July 2023) to cover claims submitted for periods up to January 2023, an official communication said.
Below is a detailed statement on the scheme’s operation:
Ghana’s National Health Insurance Scheme (NHIS) is one of the major social intervention policies bequeathed to the nation by the Act of Parliament 650 (Act 650, 2003) as amended in 2012 with Act 852 to provide access to health care.
The NHIS Benefit Package covers over 95% of disease conditions afflicting residents of Ghana and has been detailed in the NHIS Act and the membership handbook, and is published on the website www.nhis.gov.gh, with services such as outpatient, in-patient, surgery, oral and dental.
There are over 550 formulations on the NHIS Medicines list to take care of all the diseases covered under the scheme.
Membership and health providers
As of the end of 2022, the NHIS Scheme had an active membership of 17.2 million, representing approximately 55% of the population which is the highest since the inception of the scheme.
The National Health Insurance Authority (NHIA) has credentialled over 4,500 health facilities across the country comprising public, private, quasi and faith-based facilities with a variety of levels as CHPS compounds, health centres, pharmacies, diagnostic centres, primary hospitals, secondary and tertiary, with the very latest being the International Maritime Hospital (GH) Ltd (IMaH) in Tema Community One.
The public’s reliance on the use of the NHIS membership card to seek health care is still very encouraging across the country. A random sampling conducted to ascertain the use of the NHIS card in some regions of Ghana revealed the outcomes in the diagram above.
It is evident that on average over 80% of attendees to most public health-care centres attend with their NHIS membership cards with at least three different drugs dispensed per visit. This cannot be said of a scheme that is failing and accused of only dispensing paracetamol despite the rise in claims payments.
NHIA’s robust innovations
Over the past 20 years, the NHIA has undertaken several reforms to make the NHIS more efficient, attractive, and sustainable ranging from the introduction of the instant issuance of a biometric membership card system to the renewal of membership and self-enrolment using USSD (*929#) and applications (MyNHISApp) on mobile phones.
Especially since 2022, the NHIA has introduced robust innovations geared towards enhancing productivity, improving efficiency and increasing visibility and brand recognition, among other measures.
Some of the home-grown innovations comprise linkage of NHIS and Ghana Cards, partnership with Premier League clubs to increase membership, the formation of national committees against illegal payments, the launch of the MyNHIS App, the Free Elderly Health Care Policy and the Sunshine Policy.
NHIS and Ghana Cards linkage
Championing the national agenda of “One nation, one card for accessing health-care services”, the NHIA, in partnership with the National Identification Authority (NIA), intensified campaigns making it possible for people to use the Ghana card to access health-care services effective 1 May 2021.
Partnership with Premier League clubs
The Authority entered into a strategic partnership with four local Premier League clubs to register team players, management staff together with their dependants, and some fans on to the NHIS.
This initiative, a first-of-its-kind engagement, created awareness, excitement and vibrancy for the brand during match days.
NHIS Benefit Package expansion
With the aim of increasing the survival rate of children suffering from childhood cancers, the NHIS Benefit Package was expanded and made provision for the four main childhood cancers.
These are childhood neuroblastoma (cancer of the jaw and abdomen), childhood leukaemia (cancer of the blood), childhood retinoblastoma (cancer of the eye) and childhood Wilms’ tumour (cancer of the kidney).
Family planning services were also added to the benefit package after a successful pilot of the project in selected districts nationwide in July 2022.
NHIS reviews tariffs upwards
On 1 July 2022, the NHIS tariffs paid to health providers were adjusted upwards by 30% after consultation with critical stakeholders in the health sector.
Within the space of seven months, the NHIA again in February 2023 increased its tariffs for medicines and services covered by the scheme by a whopping 50% for medicines in the contracting framework, plus an additional 30% marginal increase.
Non-framework medicines were reviewed upwards by 20% while service tariffs across board have increased by 10%. These adjustments were necessitated to correspond to the increasing prices of most active pharmaceutical ingredients and management’s desire to minimise incidents of illegal charges made of NHIS members by health-care facilities.
A recent study conducted by the NHIA revealed that since the adjustments, OPD bills to the scheme have gone up by over 300%.
National committees set up to curb illegal payments
Co-payments refer to the direct out-of-pocket payments for health-care services and medications covered under the NHIS Benefit Package, and that adversely affect affordability and equality in accessing health care.
In an attempt to eliminate these financial barriers confronting the NHIS, management set up decentralised co-payment committees at the head office, regional and district offices with mandates that include engaging with the NHIA’s credentialled health-care service providers and NHIS members who are sometimes compelled to pay such extra monies for services covered by the scheme.
This is to strengthen the NHIA’s mandate of providing financial risk protection and improved access to health care for its members.
The NHIA board is currently reviewing the first national report submitted and will provide guidance on the appropriate sanctions to apply to facilities that will be found culpable. This age-old phenomenon has weakened some confidence in the scheme and must stop.
Launch of MyNHIS App
Ending the year 2022, a digital platform known as MyNHIS was unveiled in Tamale by the vice-president, Alhaji Dr Mahamudu Bawumia.
The convenient mobile app solution empowers corporate clients and other citizens to use their Ghana Card to sign up for the NHIS without necessarily visiting any of the scheme’s district offices for the service.
The new app also enables NHIS members to securely pay registration and membership renewal fees from their mobile money wallets, and bank debit cards.
The mobile application app issues a digitised NHIS Card and provides a mechanism for the NHIA to fulfil its statutory obligations.
Most importantly, the innovation delivers a vastly improved renewal experience to NHIS members, as it saves time and money, thereby making the scheme much more accessible to all residents in Ghana and beyond.
Free elderly health care
Backed by the Ministry of Health, the NHIA governing board introduced the Free Elderly Care Policy in December 2022.
The policy guarantees a waiver of the mandatory 30-day waiting period and an exemption from the payment of premium and processing fees for all members aged 70 years and above.
President Nana Addo Dankwa Akufo-Addo approved the instant health-care policy, embedded in the NHIS to address the many underlying health-related challenges faced by the older population in Ghana.
This development gave greater priority to covering the health-care needs of vulnerable groups in Ghana, especially those within the age bracket of 70 and above.
NHIA claims reimbursements
Over the years, previous management teams have had to traverse the difficult path of pooling funds from the Ministry of Finance (MoF) to pay for claims.
Though OPD cases and membership in the scheme have seen some upward trends coupled with the tariff adjustments, the NHIA today pays on average between GHC150 million and GHC200 million per month as claims reimbursements.
The table below illustrates the total claims paid to providers between 2017 and 2022, as well as payments made as of 7 July 2023.
|CLAIMS PAYMENT TO SERVICE PROVIDERS|
|Year||Amount (GHC million)|
|NB: 2023 payment is up to 7 July 2023.
Between May and June 2023 alone the NHIA paid over GHC367 million to over 4,000 health facilities across Ghana with a further payment of GHC104.5 million paid on 7 July 2023.
The NHIA’s engagement with the MoF has improved significantly, resulting in more frequent releases to the fund.
Despite the general economic climate, the MoF has ensured that funds earmarked to support the NHIS are adequately protected and released on time.
The Sunshine Policy was launched as a platform to deepen accountability, transparency and social auditing as the NHIS marks its 20th anniversary.
Since its launch in March 2023, suppliers of drugs to health-care facilities and other stakeholders are able to log on to the NHIS website with privileged access to view payments made to deserving facilities.
Hitherto, the process was opaque, which fuelled some stakeholders to accuse the NHIA, wrongly, of withholding payments due to facilities.
This new, elevated level of transparency has won the admiration of health-care managers as a critical innovation.
Electronic claims management
With the intention to improve the claims management cycle by eliminating manual submission, vetting and payment by the end of 2023, the NHIA is increasingly using the electronic claims review system, crucial for addressing fraud and abuse to ensure the financial sustainability of the NHIS.
Throughout the first quarter of 2023, 4,546 health-care providers submitted claims at a total volume of 6,492,610 to the four claims processing centres (CPCs). Out of the total volume of claims submitted, 86.3% were electronic, while 13.7% were manual.
Barely two years ago, the perverse reverse was typical, making the scheme susceptible to fraud and abuse. This high-level efficiency being injected into the management of claims will reduce abuse resulting from human and manual interventions.
Furthermore, the NHIA is on course soon to introduce electronic verification of members at the point of seeking health care. This will further reduce the incidence where duplicate claims could be submitted or recycled, thereby eliminating waste and fraud from the system.
Universal health coverage feasible
As the National Health Insurance Scheme (NHIS) continues to possibly impact people’s health-seeking behaviour and contribute to better life expectancy outcomes for Ghanaians, the NHIA remains committed to building a more resilient health insurance scheme which responds to the needs of all by providing more access to quality and affordable health-care services.
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