Accra, July 13, GNA-The National Health Insurance Authority (NHIA) has paid its
credentialed healthcare providers over GH₵471 million cedis to cover claims submitted for
periods up to January 2023 in a spate of 42 days.
A statement issued by the Authority and copied to the Ghana News Agency said for the first
time in several years, the NHIS is back into the accepted 90-day arrears window which
means that health providers are only owed two months of claims for February and March
2023.
On NHIA claims reimbursements, the NHIA boss indicated that 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 GH₵150 – GH₵200
million per month as claims reimbursements.”
“The total claims paid to providers between 2017 and 2022 as well as payments made as of
July 7, 2023 are GH₵1050.48m for 2018, GH₵803.43m for 2019, GH₵1320.29m for 2020,
GH₵1115.28m for 2021, GH₵1014.14m for 2022, and GH₵1076.00m for 2023,” he
explained.
Dr Okoe-Boye stressed that the 2023 payment is up to July 7, 2023, noting that between
May and June 2023 alone, the NHIA had paid over GH¢367 million to over 4,000 health
facilities across Ghana with a further payment of GH₵104.5 million paid on July 7, 2023.
NHIS tariffs adjustment
The statement disclosed that on July 1, 2022, the NHIS tariffs paid to health providers were
adjusted upwards by 30 per cent after consultation with critical stakeholders in the health
sector. He stated that within a space of seven months, the NHIA again in February 2023
increased upwardly its tariffs for medicines and services covered by the Scheme by a
whopping 50 per cent for medicines in the framework contracting plus an additional 30 per
cent marginal increase.
It noted that out that non-framework medicines were reviewed upwards by 20 per cent
while service tariffs across board had increased by 10 per cent.
It said these adjustments were necessitated to correspond to the increasing prices of most
active pharmaceutical ingredients and the Authority’s desire to minimise the incidents of
illegal charges made of NHIS members by healthcare facilities.
According to Statement, a recent study conducted by the NHIA revealed that since the
adjustments, OPD bills to the Scheme had gone up by over 300 percent.
NHIS benefit package
The NHIA Chief Executive said that to increase the survival rate of children suffering from
childhood cancers, the NHIS benefit package was expanded and provided for the four main
childhood cancers.
These, he mentioned, are Neuroblastoma (childhood cancer of the jaw and abdomen),
Leukemia (childhood cancer of the blood), Retinoblastoma (childhood cancer of the eye) and
Wilms Tumor (childhood cancer of the kidney).
He stated that family planning services were also added to the package, after a successful
pilot of the project in some selected districts in July 2022.
Membership
As of the end of 2022, Dr Okoe-Boye disclosed that the NHIS Scheme had an active
membership of 17.2 million, representing approximately 55 percent of the population which
is the highest since the inception of the Scheme.
“The National Health Insurance Authority (NHIA) has credentialed 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,” he said.
He observed that the public’s reliance on the use of the NHIS membership card to seek
healthcare is still very encouraging across the country. “It is evident that on average over
80% of attendees to most public healthcare centers 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,” he stressed.
GNA
LAA
July 13, 2023
