The National Health Insurance Authority (NHIA) has within 42 days paid its credentialled healthcare providers over GH¢471 million to cover claims submitted for periods up to January 2023.
A statement issued by the Authority indicated that “For the first time in several years, the NHIS is back into the accepted 90-day arrears window meaning healthcare providers are only owed two months of claims for February and March 2023”.
In a statement copied the Ghanaian Times yesterday, it stated that between May and June 2023 alone the Authority paid over GH¢367 million to over 4,000 health facilities across the country with a further payment of GH¢104.5 million paid last Friday.
“Over the years, previous management teams have had to traverse the difficult path of pooling funds from the Ministry of Finance to pay for claims.
Though Out Patients Department (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 statement said.
According to the Authority, on July 1, 2022, tariffs paid to health providers were adjusted upwards by 30 per cent and in February 2023 increased tariffs for medicines and services by 50 per cent for medicines in the framework contracting plus an additional 30 per cent marginal increase.
It indicated that non-framework medicines were reviewed upwards by 20 per cent while service tariffs across board had increased by 10 per cent explaining that these adjustments were necessitated to correspond to the increasing prices of most active pharmaceutical ingredients.
The statement said management in an effort to eliminate financial irregularities set up decentralised co-payment committees at the head office, regional and district offices with mandates that include engaging with the credentialled healthcare service providers and NHIS members who were sometimes compelled to pay such extra monies for services covered by the scheme.
It noted that the NHIA Board is currently reviewing the first national report submitted and will provide guidance on the appropriate sanctions to apply to facilities that will be found culpable, adding “this age-old phenomenon that had weakened some confidence in the scheme must stop.”
The 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.”
There are over 550 formulations on the NHIS Medicines List to take care of all the diseases covered under the scheme.
As of the end of 2022, the NHIS Scheme had an active membership of 17.2 million, representing approximately 55 per cent of the population which is the highest since the inception of the scheme with over 4,500 health facilities across the country comprising public, private, quasi, and faith-based facilities.
These include a variety of levels as Community Health Planning Systems (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.
BY TIMES REPORTER
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