Dr Bernard Okoe-Boye, NHIA Chief Executive
The National Health Insurance Authority (NHIA) has reached an impressive 85 to 95 percent success rate in electronic claims submission.
Addressing the opening of a training in expected claims generation and submission for the Tier-Three providers in Accra, the Chief Executive Officer of the NHIA, Dr Bernard Okoe- Boye, said one of the key highlights of this achievement is the substantial enhancement in payments to healthcare providers.
He stated that, with claims submission becoming more streamlined, the disbursement process had witnessed remarkable progress, stressing “it bodes well for healthcare providers across the nation, as timely payments ensure sustained healthcare services for Ghanaians”.
Role
The NHIA CEO emphasised the pivotal role played by credentialed healthcare facilities in claims processing and submission to the NHIA. He expressed satisfaction with the comprehensive training initiatives that had been implemented to equip providers with the necessary skills. This training scale-up, he noted, reaffirms the NHIA’s commitment to ensuring seamless interactions between providers and the NHIS platform.
“The combined efforts of healthcare providers and the NHIS are propelling us on a trajectory that will ultimately result in every Ghanaian receiving the healthcare they rightly deserve,” he said. He elaborated on the collaborative nature of these efforts, expressing gratitude for the support from partners such as the World Bank, UNICEF, USAID, WHO, among others.
“The partnership between the NHIA and the World Bank has paved the way for transformative changes, particularly in terms of the first three facilities: health centres, maternity homes, and chip compounds. This partnership extends from 2022 to 2025, marked by disbursement-based indicators,” he stated.
Dr Okoe-Boye indicated that membership enrollment, especially focusing on indigenes, stands as a crucial area of emphasis, noting that “the efficient processing and payment of claims for the aforementioned facilities within 90 days from submission are central targets”.
To accomplish these ambitious goals, the NHIA CEO highlighted the necessity of crafting a comprehensive work plan that meticulously outlines the strategic activities to be undertaken.
Commendation
A health economist with the World Bank, Enoch Oti Agyekum, lauded Ghana’s National Health Insurance Scheme (NHIS) as one of the most exceptional in Africa, particularly in terms of population coverage.
With a coverage rate of 55 percent in 2022, Ghana’s NHIS stood out as a remarkable achievement, coming second only to Rwanda, which boasts an impressive 79 percent coverage, mandatory for its citizens. In comparison, Senegal stands at 19 percent, Kenya at 16 percent, and Nigeria at a mere three percent.
Mr Oti Agyekum noted, “If we look across the region, the NHIS comes next to Rwanda as the best performing scheme in terms of population coverage”. He further emphasised that when considering the contextual differences between Ghana and Rwanda, the NHIS could even be considered the foremost scheme in this regard.
Mr. Agyekum also stressed the importance of focusing on ensuring effective access to services for those covered by the NHIS. He emphasised the need for individuals to receive the necessary medical attention without being burdened by additional costs, given that the scheme already covers these services.
Recognising the NHIS’s commendable initiatives, including the integration of information technology (IT) for claims processing, Mr. Agyekum expressed his appreciation for the steps taken to improve the overall system.
However, he also pointed out that there were areas where the NHIS might face limitations, particularly in facilities such as community-based health planning services (CHPS), health centers, and maternity homes. These facilities might not fully benefit from the scheme due to issues such as poor network connectivity and lack of essential amenities.
The World Bank Health Economist, therefore, highlighted the importance of training participants to generate claims manually when needed, providing an alternative method to ensure effective implementation.
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