The number of NHIS participants reaches 17.2 million, the highest number ever.

By the end of 2022, 17.2 million people were actively enrolled in the National Health Insurance Scheme (NHIS), or around 55% of the population.

The number represents the scheme’s peak membership at any given time.

The National Health Insurance Authority (NHIA) Chief Executive, Dr. Bernard Okoe-Boye, stated at a news conference in Accra last Friday that despite the high subscription, the NHIA has paid more than GH471 million to its 4,500 qualified healthcare providers across the country.

The sum covered claims submitted to the authority for periods up to January 2023, and it was paid out within 45 days from May 24 to July 7, 2023.

The payments, according to Dr. Okoe-Boye, had returned the NHIS to the 90-day arrears window for the first time in many years. Previously, service providers were occasionally owing for up to 12 months.

The recognized health facilities include various primary, secondary, and tertiary hospitals as well as governmental, commercial, quasi-government, and religious hospitals as well as Community-based Health Planning and Services (CHPS) facilities.

paying promptly

Dr. Okoe-Boye made a button click during the ceremony to denote the final payment of GH105 million to service providers using an automated payment mechanism.

He stated that only two months (February and March) were currently behind. I’m delighted to report that the faulty arrears for the past two months are among the lowest we’ve seen since the program’s commencement. We want the general public to be aware so that hospitals and service providers can no longer utilize the defense that we haven’t been paid.

He stated that the authority also took two to four weeks to review claims before making payments, while service providers often needed four to six weeks to submit their paperwork for claims payment.

So, he explained, “A window is permitted for receiving the claims and paying them.

We pay them every 30 days, but after a while, we realized that they are the only ones who know because they keep informing their suppliers that they haven’t been paid for a while, he added.

He claimed that the authority implemented the “sunshine policy,” which gave privileged access to all stakeholders, including suppliers of drugs and other consumables to healthcare facilities, to allow them to view payments made each month to deserving facilities and correct instances of misinformation.

Tariff modification

Dr. Okoe-Boye stated in February 2023 that the NHIS tariffs paid for medications and services covered by the program were increased by 50% to reflect the rising costs of the majority of active pharmaceutical components. NHIS members were rarely forced to pay unauthorized fees by healthcare establishments.

“Our claims payout was GH150 million on average every month. It increased sharply to around GHC 200 million. We made the increased adjustment after service providers complained that the rates we pay for drugs under our benefit packages did not correspond to the market costs, the official added.

According to research, the authority had performed, outpatient department (OPD) bills to the program had increased by almost 300% since the revisions, he claimed.

He claimed that the NHIS prices paid to healthcare providers have already been increased by 30% as of July 1, 2022, following consultation with important industry partners.

Resilient plan

According to Dr. Okoe-Boye, the NHIA is dedicated to creating a robust health insurance program that responds to the population’s healthcare requirements by granting access to high-quality, reasonably priced healthcare services.

He claimed that the NHIS benefit package covered more than 95% of the diseases that the Ghanaian populace was aware of and that it had been found that, on average, more than 80% of people who visited the majority of public healthcare facilities did so with their NHIS membership cards, with at least three different medications being prescribed per visit.

He claimed that the program had so far increased its benefits offerings and added illnesses including children’s tumors and medications for breast cancer patients.

“In the past, parents of children with cancer had to cover the costs out of their own pockets; today, the NHIA pays the expenditures. I’m also pleased to report that the NHIA will begin covering mental health disorders before the year is over.

People with mental health disorders won’t have to worry about scrambling to come up with the cash to pay for therapy, he said, adding that the details are now being worked out.

He pleaded with the media to work with the authorities to inform and educate the public about easier access to high-quality medical treatment.

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