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NHIA Pursues Reforms to Enhance Healthcare Access, Eliminate illegal charges
The Chief Executive of the National Health Insurance Authority (NHIA), Dr. DaCosta Aboagye , says the Authority is pursuing pragmatic reforms to upgrade the National Health Insurance Scheme.
This ambitious reform is expected to among others, enhance the operations of service providers to improve healthcare delivery and expand access towards Universal Health Coverage.
He mentioned components of the reforms to include prompt payments of vetted claims to ensure payments were current; automatic price adjustment to regulate pharmaceutical pricing; E-pharmacy policy to enhance medication accessibility under the scheme and the collaboration with the National Identification Authority to provide Ghana cards for 6.3 million young people between 6 and 14 to enable them be captured unto the NHIS.
He also mentioned the automatic absorption of all SSNIT contributors into the Scheme without additional payment.
He was speaking at the opening of the 4th Annual Conference of the Private Health Facilities Association of Ghana in Koforidua on September 18, 2024.
The conference, which has become a prominent gathering for private healthcare providers, pooled industry players, policy makers, healthcare consumers, and traditional leaders to discuss challenges and opportunities in healthcare delivery.
“We are reforming and upgrading the National Health Insurance Scheme (NHIS), and our aim is to eliminate delays in payments to facilities to improve service delivery and access,” he said.
Dr Dacosta Aboagye expressed confidence that these reforms will make the health system more robust, ending illegal payments also known as copayments, a phenomenon he described as a major threat to the effectiveness and sustainability to the National Health Insurance Scheme (NHIS).
“We are working hard to end co-payments through two key measures: system reforms and the establishment of a task force.
“If the NHIA is paying claims on time and providing adequate tariffs, no facility has the moral right to charge patients additional fees,” he stated.
He assured the private health facilities that the NHIA is committed to maintaining regular payments, as part of broader reforms aimed at improving the NHIS.
Prompt payment
Throwing more light on prompt payment, he said over the past few months, the Authority has paid out claims at an unprecedented rate, more than any other government in the Fourth Republic.
He underscored the NHIA’s current efforts in improving payment systems to healthcare facilities, noting significant progress made in recent months.
He shared that the NHIA has made substantial payments to health facilities to clear long-standing debts.
“In 2016, the entire budget of the NHIS was around GH¢1.2 billion, and there was a backlog of one year of unpaid claims.
“Just last week, I authorised the release of GH¢800 million for healthcare facilities, with 400 million already disbursed.
“Today, I am pleased to announce that we have begun the disbursement of an additional GH¢402 million. We have made payments up to July,2004 to all facilities that have submitted claims,” he said.
Emphasising the NHIA’s objective to eliminate debts to healthcare facilities, he assured stakeholders that claims submitted would be processed promptly.
Tariff review
The Chief Executive also addressed concerns on the ongoing tariff review process, recognising the need for speed and effectiveness.
“While we have reviewed tariffs multiple times in recent years, pricing remain an anchor for both public and private facilities to charge illegal fees. For this reason, in this regime, our approach is let’s do it well, that is why it has kept long.
“We have invited all stakeholders, development partners, everybody that matters to the table, trying to make sure that we get it right. This is why the process has delayed.
“Our goal is to introduce an automatic price adjustment mechanism that will help stabilise prices, especially in the pharmaceutical sector,” he said.
Dr Aboagye said the current manifesto of the ruling New Patriotic Party includes plans for an automatic price adjustment within a regulatory framework to prevent arbitrary pricing by pharmaceutical companies.
He explained that the automatic price adjustment system will prevent pharmaceutical companies from arbitrarily increasing prices, as it will be regulated within a framework determined by the independent tariff review.
“We are committed to ensuring that both public and private facilities benefit from fair and sustainable pricing.
“What this means is that under no circumstances will pharmaceutical companies be allowed to charge anything that they want. Prices will be determined automatically by the stakeholder approved regulatory framework under the independent tariff review, when it comes up,” he said
E-pharmacy policy
He said an E-pharmacy policy aimed at streamlining medication access is also currently being piloted.
“This initiative allows pharmacies under the NHIS to upload prescriptions of medications they don’t have but a patient need on an online platform, facilitating medication collection at any local pharmacy near them or even in some instances have them delivered to their homes with the aid of the property addressing system.
“As reforms continue, the NHIA remains committed to enhancing the robustness of Ghana’s health system, ensuring that all citizens can access quality care.
Dr. Aboagye emphasised the importance of the private health sector to the overall health delivery system in Ghana.
He acknowledged the critical role private health facilities play in extending healthcare access to Ghanaians and pledged the NHIA’s continued support to ensure their sustainability.
“I am so delighted to stand before you at such a crucial time for the health sector. Your contribution is highly appreciated by the National Health Insurance Scheme,” Dr. Aboagye said.
Source: DOREEN ANDO
