In a space of 42 days – May 24 to July 7, 2023 – the National Health Insurance Scheme has paid its credentialed healthcare providers over GH¢471million to cover claims submitted for periods up to January 2023. 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.
Mandate
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 healthcare.
The NHIS Benefit Package covers over 95 percent of disease conditions that afflict residents of Ghana; and has been detailed in the NHIS Act, Membership Handbook, and published on the website – www.nhis.gov.gh with services such as outpatient, in-patient, surgeries, 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 & Health Providers
As at the end of 2022, the NHIS Scheme had an active membership of 17.2 million representing approximately 55 percent of the population – which is the highest since 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) (IMaH) in Tema Community One.
The public’s reliance on use of the NHIS membership card to seek healthcare is still very encouraging across the country. A random sampling conducted to ascertain the use of NHIS cards in some regions of Ghana revealed the outcomes in the diagram above. It is evident that on average over-80 percent of attendees to most public healthcare 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 introducing 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 toward enhancing productivity, improving efficiency and increasing visibility and brand-recognition among others. Some of the hom-grown innovations comprise NHIS and Ghana Cards linkage, Partnership with premier league clubs to increase membership, the formation of National Committees against Illegal payments, launching the MyNHIS App, the Free Elderly Healthcare policy and the Sunshine Policy.
NHIS and Ghana Cards linkage
Championing the national agenda of ‘One nation, one card for accessing healthcare 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 healthcare services effective May 01, 2021.
Partnership with local 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 dependents and some fans onto the NHIS. This first-of-a-kind move created some 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: which 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). Family Planning services were also added to the Benefit Package after a successful pilot of the project at some selected districts nationwide in July 2022.
NHIS reviews tariffs upward
On July 1, 2022, the NHIS tariffs paid to health providers were adjusted upward by 30 percent after consultation with critical stakeholders in the health sector. 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 percent for medicines in the framework contracting, plus an additional 30 percent marginal increase. Non-framework medicines were reviewed upward by 20 percent while service tariffs across the board have increased by 10 percent.
These adjustments were necessitated to correspond with the increasing prices of most active pharmaceutical ingredients, and management’s desire to minimise the incidents of illegal charges made on NHIS members by healthcare facilities. A recent study conducted by the NHIA revealed that since the adjustments, OPD bills to the Scheme have gone up by over 300 percent.
National committees set up to curb illegal payments
Copayments refer to the direct out-of-pocket payments for healthcare services and medications covered under the NHIS Benefit Package, and that adversely affect affordability and equality in accessing healthcare.
In an attempt to eliminate these financial barriers confronting the NHIS, management set up decentralised Copayment Committees at the Head Office, Regional and District offices – with mandates that include engaging with the NHIA’s credentialed healthcare 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 healthcare for its members. The NHIA Board is currently reviewing the first national report submitted, and will provide guidance on the appropriate sanctions to apply on facilities that are found culpable. This age-old phenomenon has weakened some confidence in the Scheme, and it must stop.
Launch of MyNHIS App
Ending the year 2022, a digital platform known as ‘MyNHIS’ was unveilled in Tamale by Vice President Alhaji Dr. Mahamudu Bawumia. The convenient mobile App solution empowers corporate clients and other citizens to use their Ghana Cards to sign up for the NHIS without necessarily visiting any of the Scheme’s district offices for the same 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 healthcare
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 healthcare 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 healthcare 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 GH¢150 – GH¢200million 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 7th July 2023.
| Claims payment to service providers | |
| Year | Amount (GH¢million) |
| 2018 | 1,050.48 |
| 2019 | 803.43 |
| 2020 | 1,320.29 |
| 2021 | 1,115.28 |
| 2022 | 1,014.14 |
| *2023 | 1, 076.00 |
| NB: 2023 payment is up to 7th July 2023. | |
Between May & June 2023 alone, the NHIA paid over GH¢367million to over 4,000 health facilities across Ghana – with a further payment of GH¢104.5million paid on July 7, 2023. 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.
Sunshine policy
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 healthcare facilities and other stakeholders are able to log onto the NHIS website with privileged access to view payments made to deserving facilities. Hitherto, the process was opaque – which fuelled some stakeholders to wrongly accuse the NHIA of withholding payments due to facilities. This highest level of transparency has won the admiration of healthcare 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 financial sustainability of the NHIS.
Throughout the first quarter of 2023, 4,546 healthcare providers submitted claims at a total volume of 6,492,610 to the four Claims Processing Centres (CPCs). Out of the total volumes of claims submitted, 86.3 percent were electronic while 13.7 percent were manual. Barely two years ago the process was mainly manual – 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 to soon introduce electronic verification of members at their point of seeking healthcare. This will further reduce the incidence of duplicate claims being submitted or re-cycled, thereby eliminating waste and fraud from the system.
Universal Health Coverage (UHC) feasible
As the National Health Insurance Scheme (NHIS) continues to impact people’s health-seeking behaviour and contribute to better life-expectancy outcomes for Ghanaians, the NHIA is committed to building a more resilient health insurance scheme that responds to the needs of all by providing more access to quality and affordable healthcare services.
