Ghana’s National Health Insurance Scheme (NHIS) has received praise from the World Bank for being among the finest in Africa, particularly in terms of population coverage.
Following Rwanda, whose coverage is required at 79%, Ghana finished in second with a 55% coverage rate in 2022.
Senegal accounts for 19%, Kenya for 16%, and Nigeria for 3%.
This was said by Enoch Oti Agyekum, a health economist with the World Bank, yesterday in Accra at the start of a training session on projected claims creation and submission for Tier-Three providers.
According to him, the NHIS is doing extremely well, and “if we look across the region, the NHIS comes next to Rwanda, as the best performing scheme in terms of population coverage.”
“But I will even say that the NHIS is the best because the context of Rwanda is different from that of Ghana and so in terms of population coverage, if you want to clap you can do it better for Ghana,” he added.
In order to make the reach effective, according to Mr. Agyekum, it is now necessary to make sure that when people visit the facilities, they receive the services they seek.
Additionally, they shouldn’t be required to pay for any treatments covered by the NHIS.
In many meetings when NHIS was criticized for not paying on time, Mr. Agyekum noted that one of the causes had been that the providers had also been tardy in filing their claims.
He said that the service providers frequently did not submit them in a way that would enable effective delivery.
The World Bank acknowledged the several efforts the NHIS has started, including the use of information technology (IT) to simplify the creation and processing of claims, according to The Health Economist.
However, Mr. Agyekum emphasized that because of the weak network and absence of other amenities, institutions like community-based health planning services (CHPS), health centers, and maternity homes would not benefit too much.
According to the World Bank Health Economist, the training was a preventative strategy to assist the participants in producing claims manually as was anticipated.
Concerning claims payment by the NHIS, Dr. James Duah, the Deputy Executive Director of the Christian Health Association of Ghana (CHAG), stated that recent payment has been more forward-looking than prior years.
“If you do data analytics, you need three points to establish a point and so far we have had those three points; the trend looks good and we are hopeful that this training would also contribute to enhance the processes and early payment,” he added.
Dr. Duah hoped that the training would encourage early claim submission.
According to him, CHAG started digitizing its operations with three member facilities in 2018, but as of right now, 331 CHAG facilities are filing claims online.
The World Bank and the National Health Insurance Authority (NHIA) were applauded by the deputy executive director of CHAG for working together to teach members to make it easier to submit claims, which would satisfy both parties.
Dr. Andre Kwasi-Kumah, president of the Society of Private Medical and Dental Practitioners (SPMDP) Ghana, said the organization also valued the recent timely and regular payments from the NHIA and hoped that trend would continue.