The National Health Insurance Scheme (NHIS) had an active membership of 17.2 million by the end of 2022, representing approximately 55 percent of the population.
The figure is the highest membership of the scheme at any particular time.
At a news conference in Accra last Friday, the Chief Executive of the National Health Insurance Authority (NHIA), Dr. Bernard Okoe-Boye, said despite the high subscription, the NHIA had paid more than GH471 million to its 4,500 credentialed healthcare providers across the country.
The amount, which was paid within 45 days from May 24 to July 7, 2023, covered claims submitted to the authority for periods up to January 2023.
The payments, Dr. Okoe-Boye said, had brought the NHIS back to the 90-day arrears window for the first time in many years, as service providers previously were sometimes owed for as long as up to 12 months.
The certified health facilities comprise public, private, quasi-public, and faith-based health facilities, Community-based Health Planning and Services (CHPS) compounds, health centers, pharmacies, diagnostic centers, and some primary, secondary, and tertiary hospitals.
Paying on time
At the event, Dr. Okoe-Boye clicked a button to signify the payment of the last tranche of GH105 million to service providers through a computerized payment system.
Currently, he said, “Only two months (February and March) were in arrears. I am happy to announce that these two months of defective arrears are one of the lowest we have had since the inception of the scheme. We want the public to know so that the excuse made by hospitals and service providers that we have not been paid will not hold anymore”.
He explained that the service providers took about four to six weeks to process their documents for claim payment, while the authority also took two to four weeks to vet claims before making payments.
“So, a window is allowed for receiving the claims and paying them,” he said.
“Every 30 days, we make payment, but for some time, we realized that when we pay them, they are the only ones who know, and they keep telling their suppliers that for a long time they have not been paid,” he said.
He said the authority launched the Sunshine Policy, where every supplier of drugs and other consumables to health facilities and other stakeholders with privileged access were able to log onto the NHIS website to view payments made each month to deserving facilities to correct the incidence of misinformation.
Tariff adjustment
In February 2023, Dr. Okoe-Boye said the NHIS tariffs paid for medicines and services covered by the scheme were increased by 50 percent to correspond to the increasing prices of most active pharmaceutical ingredients. To minimize the incidents of illegal charges, NHIS members were made to pay by healthcare facilities.
“Our claims payment was an average of GH150 million a month. It has jumped to close to GH200 million. We did the upward adjustment after we received comments from the service providers that the prices we pay for medicines on our benefit packages were not matching the market prices,” he said.
Since the adjustments, he said, a study conducted by the authority had established that outpatient department (OPD) bills to the scheme had gone up by over 300 percent.
Already, on July 1, 2022, he said, the NHIS tariffs paid to health providers were adjusted upwards by 30 percent after consultation with critical stakeholders in the health sector.
Resilient scheme
Dr. Okoe-Boye said the NHIA was committed to building a resilient health insurance scheme that responded to the health needs of the citizenry by providing access to quality and affordable healthcare services.
The NHIS benefit package, he said, covered more than 95 percent of disease conditions known among the Ghanaian public, while it had been established that on average, over 80 percent of attendees to most public healthcare centers attended with their NHIS membership cards, with at least three different drugs dispensed per visit.
The scheme, he said, had so far expanded its benefit package and added conditions such as childhood cancers and drugs for women suffering from breast cancer.
“Parents who had children with childhood cancers had to pay from their pockets, but now the bills are brought to the NHIA and we pay. I am also happy to announce that, before the end of this year, the NHIA will, for the first time, pay for mental health conditions.
“We are working on the details now; people with mental health conditions will not have to go through the stress of finding money to access treatment,” he said.
He urged the media to partner with the authority to sensitize and educate the public on increased access to quality health care.
Source: GraphicOnline
