NHIS funding challenges due to escalating claims cost – Director
He said the increasing cost of claims was due to extremely high medicine prices, irrational prescription behaviour, supply induced demand and weak referral systems among others.
Mr Suleymana made the attribution during the commemoration of the 15th anniversary of the Enactment of the National Health Insurance Act, 2003 (Act 650) in Wa.
He said in response to the challenges, the Executive Management of the NHIA came up with four foundation pillars, namely, improving financial model of the scheme, improving claims management through e-claims, improving accountability and quality assurance and enhancing the existing legal provision.
Also, to ensure quality of service, data integrity and privacy, the Authority has over the years progressively invested heavily in building robust state-of-the-art Management Information systems (MIS).
This comprises both hardware and software for management of operational models such as membership, claims, complaints, quality assurance, finance, audit and human resources.
Mr Suleymana said with innovative management, the scheme has made significant strides since its introduction some 15 years ago including increase in membership coverage, increase in health service utilization and increase in per capita utilization among others.
“With co-payment and cost sharing, Ghana’s NHIS is reported to have the most ‘generous’ benefit package among its peers”, the Upper West Regional NHIA Director, said.
He noted that the benefit package covered about 95 per cent of all reported illness in health facilities across Ghana, adding that the benefit package was the same irrespective of one’s socio-economic status and membership categorization.
On provider remuneration systems, Mr Suleymana said the NHIS has transitioned from the itemized billing system to pay health service providers under the erstwhile District Mutual Health Insurance Schemes (DMHISs); and further to a system that is made up of diagnostic and fee for service.
The NHIS Regional Director noted further that in 2008, the NHIS took an important step in reforming the payment system through the introduction of the Ghana diagnostic related grouping system for services; fee for service for medicines.
Mr Suleymana said to ensure efficiency in claims management, the NHIA has started an e-claims management system in some selected health service providers; and has established four claims processing Centers (CPCs) across the country to receive and process claims.
“As Ghanaians, we got to be proud of ourselves that we have been able to establish a ‘home grown’ health insurance scheme which has become a model of health financing in Africa and the world as a whole”, he said.
Meanwhile, Officials of the NHIA in the region together with other stakeholders have embarked on a health walk through the principal streets of Wa to remind the public on the need for regular exercise and also to raise awareness about the day and the activities of the scheme in the region.