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The National Health Insurance Administration (NHIA) has announced that, beginning in 2023, it would include prostate cancer treatment and medicines among the malignancies that are covered at no cost.
The scheme’s actuarial analyses have shown that it is feasible and viable, and other preparations for takeoff are nearing completion.
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Dr. Bernard Okoe-Boye, the NHIA’s CEO, made the announcement at a meeting with President Nana Addo Dankwa Akufo-Addo at the Jubilee House in Accra to discuss the agency’s progress and get his signature on many new policies.
He said that as of the end of January 2017, kids cancers were not included in the scheme’s coverage, but that four types of cancer, accounting for 80% of all childhood cancers in Ghana, had just been included.
He mentioned that the regimen had been expanded to include Herceptin, a key therapy in the treatment of breast cancer, and hydroxyurea, a potent medication that improved the quality of life for those with Sickle Cell anemia.
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Claims
Dr. Okoe-Boye indicated that as of 2017, payment arrears totaled over GH1billion, or more than a year’s worth of work, but that they had been reduced to eight months; this would leave roughly four or five months after subtracting the three months needed for processing and vetting.
Comparatively, he thought five months was a healthy estimate, but he was confident that the current plan would clear all the regions in record time.
Challenges about the policy
The processing costs of GH6 and the premium of GH25 were implemented over 17 years ago, he said, and at times the program spent more on processing than was originally anticipated.
He also mentioned that the non-SSNIT contributor premium of GH26 had not been changed in 16 years and was overdue for an evaluation.
Costs that aren’t legal
He stated that the board had taken action to identify the issue of unlawful charges, sometimes known as co-payment, and the causes that inspired the practice, such as assertions by facilities that the tariffs were not practical.
As of July 1, 2022, the system increased the agreed upon increase in drug and service rates for providers by 30%.
The plan and its stakeholders conducted a pricing study and settled on this value, which is based on inflation and other factors.
Dr. Okoe-Boye briefed the President and reported that the system has reduced its payment delay from a full year to five months, with monthly payments to providers averaging GH100 million (or GH1.2 billion annually).
Lies disguised as arguments
Dr. Okoe-Boye informed the President that beginning in 2019, biometric verification would be performed at the various facilities in the NHIS program, capturing details about cardholders whenever they accessed NHIS-related services.
This would make it more difficult for fraudulent claims to be submitted.Those found to be dishonest in their employment for the NHIS will be fired, he warned.
Akufo-Addo has stated that biometric authentication of patients is a crucial step in establishing real-time, verified claims.
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