The National Health Insurance Scheme (NHIS) is leveraging the Ghana National Electronic Pharmacy Platform (E-pharmacy) to combat illegal charges, commonly referred to as co-payments.
Co-payment in the context of the NHIS involves NHIA-credentialed facilities charging scheme members for services and medications paid for by the Scheme.
The Chief Executive of the NHIA, Dr. Da-Costa Aboagye, shared this information during a series of staff durbars held across the country, where he engaged with employees on enhancing the Scheme and his welfare enhancement plans.
The most recent gathering took place last Friday at the Authority\u2019s head office in Accra.
He appealed to all credentialed facilities and staff members to support his vision of eliminating illegal charges.
Dr. Aboagye emphasised that ending this illegality is a shared responsibility, urging staff and other stakeholders to refrain from aiding such acts and to remain vigilant against facilities that perpetuate these practices.
He underscored the necessity of this effort for the sustainability of the Scheme and the jobs of all staff members.
He indicated that co-payments represent a significant concern for the Authority and NHIS beneficiaries, as they often lead to unexpected out-of-pocket expenses for services and medications that are fully covered under the NHIS.
He noted that such practices create barriers to access and undermine the core objective of the NHIS, which is to ensure equitable healthcare for all.
He reiterated that the NHIS covers diagnosis and treatment for 95 percent of primary healthcare needs, and the NHIS expects that no member of the scheme will incur additional charges for these services and medications.
\u201cUnfortunately, despite extensive efforts and awareness creation, illegal charges continue to persist, especially in the dispensing of prescribed medications to members.
\u201cAs part of my commitment to address this issue and enhance the performance of the scheme and health outcomes, the E-pharmacy policy is currently being integrated with the NHIS. It is currently being piloted in the regions of the North, with plans for a nationwide rollout to follow.\u201d
E-pharmacy Policy
Elaborating on the E-pharmacy initiative, Dr. Aboagye explained that the policy requires that if a credentialed pharmacy, whether within a healthcare facility or standalone, does not have a prescribed medication in stock, it must upload the prescription to the E-pharmacy platform.
\u201cThis enables the system to locate another credentialed facility within the member’s community that has the medication available, allowing the member or patient to be directed to that location for collection.
\u201cAlternatively, with the assistance of the property addressing system, the medication can be delivered to the member at home in line with terms and conditions,\u201d he said.
He said the E-pharmacy is currently being piloted in the regions of the North, with plans for a nationwide rollout soon.
He explained that the integration of this digital platform with the NHIS will significantly reduce opportunities for illegal charges on medications that should be covered because members can verify the availability of their medications in real-time, ensuring they are not pressured into making unauthorized payments.
\u201cThis move aligns with our mandate to protect beneficiaries and ensure that all services covered under the scheme remain free at the point of delivery,\u201d he emphasized.
\u201cThis approach not only promotes collaboration among pharmacies but also ensures that patients can receive their medications without undue delay,\u201d he said.
Other Benefits
The NHIA Boss said the E-pharmacy initiative also promises to utilize real-time data to track medication dispensing patterns across pharmacies.
He said that capability will empower the NHIS to identify and address discrepancies in co-payments more effectively.
\u201cBy centralizing the pharmacy services, the NHIA can swiftly address cases of non-compliance among accredited facilities, implementing sanctions as necessary to uphold the integrity of the Scheme.
\u201cThe E-pharmacy integration is therefore expected to increase transparency and accountability within the scheme, easing the financial burden on NHIS members. This effort is part of the NHIA\u2019s broader agenda to streamline service delivery under the NHIS and expand access to quality healthcare.
\u201cBy tapping into digital solutions like the E-pharmacy platform, the NHIS hopes to significantly reduce illegal charges and enhance the overall experience for NHIS subscribers.
Dr Aboagye said this initiative comes at a critical time as the NHIS seeks to enhance the effectiveness and sustainability of the NHIS, which is designed to provide comprehensive healthcare coverage to the entire population.
\u201cCo-payment has become a major challenge for our scheme. We are committed to addressing this issue through systems, enforcement, and meaningful engagements with service providers,\u201d he said.
Co-payment Drivers \/ Solutions
Dr. Aboagye said the issue of co-payment has long been a concern for the Authority and NHIS members, who report frequent charges at both hospitals and pharmacies.
He noted that some health facilities have cited delays in the payment of claims and low tariffs for medications under the NHIS, as compared to market prices, as reasons for charging NHIS members additional fees.
Insisting that no reason justifies the illegality, the NHIS appreciates their concerns and has worked hard to ensure prompt payment of claims.
\u201cIn tandem with the E-pharmacy initiative, the NHIS has been proactive in addressing payment delays that have contributed to the co-payment issue,\u201d he said.
Dr. Aboagye noted that the government has made substantial financial investments aimed at bridging payment gaps and improving service provider tariffs, ensuring that healthcare facilities can operate sustainably without resorting to illegal charges.
Dr. Aboagye reported that the government, through the NHIA, has been proactive in ensuring that all submitted and vetted claims are paid promptly. \u201cWe have worked hard to ensure no outstanding claims as of now.
\u201cCurrently, we have paid up to August and are calling on NHIA-credentialed facilities to submit their claims for prompt vetting and payments,\u201d he said.
He said by streamlining the reimbursement process, the NHIA aims to eliminate the financial pressures that can lead healthcare providers to impose illegal charges. These efforts are designed to ensure that healthcare facilities can operate sustainably without resorting to illegal charges.
\u201cOur commitment to addressing the issue of co-payments is a significant aspect of our reforms,\u201d Dr. Aboagye affirmed.
Tariffs
On Low tariffs, Dr. Aboagye stated that while the Authority has been collaborating with stakeholders to frequently review tariffs to help service providers break even, it is currently working around the clock to ensure an automatic tariff adjustment policy that will address their concerns.
\u201cCurrently, the tariffs in force are based on consensus by all stakeholders and therefore, while we have ensured that claims are paid promptly, we expect that no member is charged any additional fees.
\u201cThis is illegal and will soon be punishable by law. At the moment, service providers do not have any moral grounds to continue charging NHIS members for any service and medication on the inclusion list of the NHIS.
\u201cThe NHIA’s commitment to eliminating co-payments is part of a broader strategy to enhance service delivery and improve access to quality healthcare for all Ghanaians,\u201d he said.
Background
The E-pharmacy platform, which officially launched in January 2023 following a successful six-month pilot, has been welcomed by both the government and stakeholders in the pharmaceutical industry.
Vice President Dr. Mahamudu Bawumia, who played a pivotal role in the initiative’s development, expressed his enthusiasm for the convenience it will bring to Ghanaians.
The platform enables registered pharmacies to offer a streamlined process for uploading and purchasing prescribed medicines, which can then be delivered directly to patients’ homes upon registration with their Ghana cards.<\/p>\n","protected":false},"excerpt":{"rendered":"
The National Health Insurance Scheme (NHIS) is leveraging the Ghana National Electronic Pharmacy Platform (E-pharmacy) to combat illegal charges, commonly referred to as co-payments.Co-payment in the context of the NHIS involves NHIA-credentialed facilities charging scheme members for services and medications paid for by the Scheme.The Chief Executive of the NHIA, Dr. Da-Costa Aboagye, shared this…<\/p>\n","protected":false},"author":2,"featured_media":4564,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[869,758],"class_list":["post-4562","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-aboagye-dacosta","tag-nhia","th-blog blog-single has-post-thumbnail"],"yoast_head":"\n