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.
Addressing a press conference at the NHIA head office in Accra, the Chief Executive Officer (CEO), Dr. Bernard Okoe-Boye, 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 further stressed that the 2023 payment is up to July 7, 2023, noting that between May and June 2023 alone, the NHIA had paid over GHC 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
He 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.
Dr. Okoe-Boye also pointed out that non-framework medicines were reviewed upwards by 20 per cent while service tariffs across board had increased by 10 per cent.
These adjustments, he said, 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 him, 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 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, 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.
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.