The NHIS under Dr. Bernard Oko Boye, the reforms and achievements [Article]

It is public knowledge that the first law that established the NHIA (Act 650, 2003) has since been amended to Act 852 in 2012.

We can say without any equivocation that since the NPP government came into office in 2017, the National Health Insurance Scheme (NHIS) has witnessed considerable progress toward the attainment of universal health coverage (UHC).

As at end of December 2021, the Scheme recorded an active membership of 16.7 million representing 54 percent of the population, the highest since its inception 19 years.

The Management and Board of the Authority continue to draw inspiration from the President’s audacious vision, policies and programmes for this country and have set out for themselves very ambitious targets including a membership coverage of 57% for the year 2022.

This makes it imperative for management and the board to adopt innovative approaches to achieve the desired deliverables. This commitment by both Management and the board has led to a strategic overhaul of the operations of the scheme with the adoption of digital technology as a transformative tool for improving the fortunes of the scheme and overall health outcomes for Ghanaian people.

The main agenda underpinning the transformational changes under the scheme led by Dr. Oko Boye is what he called the 5D Strategy which has been adopted by management and Board.

The 5D strategy focuses on digitisation of NHIA operations, Data analytics, development of both human and physical infrastructure of the Authority, Decentralization of NHIA Operational architecture and Dissemination of information. This five-prong strategy is changing the face of the scheme and the outcome has so far been phenomenal.

Introduction of NHIA mobile renewal using the short code *929#

This is an App that allows NHIS members to renew their NHIS membership in the comfort of their homes and for their families, friends and relations using either android or yam phone without having to physically visit any NHIS office.

This novelty has helped to eliminate the long queues that used to characterise NHIA District offices with many Ghanaians having had to sleep in the precincts of the NHIA offices for days just to have their NHIS cards renewed.

This is not to talk of the poor who have had to travel from the hinterlands to district capitals where NHIA offices are located with transportation costs sometimes higher than the premium.

Yes, this is the relief government has brought for the Ghanaian people.

Electronic claims Management

To eject efficiency and cost-effectiveness into the claims, the Management of the Authority under Dr. Oko Boye introduced technology to reduce abuse, the Authority brought in an electronic claims management system.

Only 10 percent of the claims were being processed electronically with the rest 90 percent processed manually.

This obviously resulted in substantial abuse leading to payment of unearned monies to providers. But, I’m happy to inform you that the situation has since been turned around with 70 percent of the claims now being processed electronically and 30 percent manually processing.

Drawing from the efficiency gains (benefits) from electronic claims processing such as a reduction in the turn around time from 80 days to 40 days, reduction in fraud and abuses associated with the manual claims vetting amongst other benefits, the Authority has set out to achieve full (i.e100 percent) electronic claims processing by June 2023 a target far beyond the NPP 2020 Manifesto promise of 90 percent electronic claims processing by 2024. Yes, this is how efficient the government is managing the taxpayer money for the benefit of the Ghanaians.

Expansion of the benefits package:Since 2017, a number of health conditions hitherto, not included in the NHIS Benefit package have been included. These include Family planning services and 4 childhood cancers (Neuroblastoma- cancer of the jaw and abdomen, Leukemia -cancer of the blood, Retinoblastoma -cancer of the eye and Wilms Tumor – cancer of the kidney. The actuarial work on these childhood cancers has been completed for inclusion in 2023.

Claim Payment

One of the critical areas that determine the sustainability or otherwise of a scheme is its ability to pay its service providers or hospitals on time. In the past, it was a common feature of the scheme to owe healthcare providers or hospitals between 10 and 12 months and even beyond in claims payment. This gravely affected the quality of healthcare services provided to members which invariably resulted in low membership renewal. As we speak, our indebtedness to hospitals or services providers has been reduced to an average of 5 months with a commitment to further bring it down to between 2 and 3 months. It is instructive to note also that the Authority pays in excess of 100 million Cedis each month to its 5,000 credentialed hospitals or health care providers and an average of 1.2 Billion Cedis annually. This makes it incumbent upon us to adopt effective cost containment and or efficiency measures to ensure the sustainability of the scheme.

What to expect

The future of the scheme will be driven by two things-technology and the protection of the vulnerable. To this end, the Authority has come out with the following innovations;

MyNHISApp. – To make NHIS enrolment more accessible, friendly and convenient to the Ghanaian, Management has launched an App named MyNHISApp.

The launch was done by His Excellency Vice President Dr Mahamudu Bawumia last week Friday at Tamale.

This App allows for self-NHIS registration, registration of families, friends and relations.

For the first time in the 19 years history of the Scheme, Ghanaians can get onto the NHIS without having to physically present at any NHIS district office or registration centre.

All that one requires is to have a Ghana Card

Secondly, the implementation of Biometric Authentication/ verification of members at Provider sites: One of the missing links in the NHIS claims management is verification of facility attendance by members. There is a need to validate attendance at the hospital for which claims are being paid. Lack of this system has resulted in false claims and abuses over the years. Going forward, the Authority in collaboration with the National Identification Authority, NIA intends to implement a biometric verification solution that will validate in real-time, the attendance of all members who visit hospitals or healthcare facilities. This will help eliminate fraud and abuse of the system. Yes, these are efficiency or cost-saving measures Ghanaians will see under the current management.

Protection of the Vulnerbale

The primary focus of the scheme is to protect the poor and the vulnerable against the cost of basic quality healthcare. The existing benefits package has free maternal policy, waiver of all payments by the poor, children under 5 years and pregnant women. The NHIS under this government has implemented a free elderly care policy.
The policy of free elderly care will see the waiver of the current 30 days waiting period and the payment of charges or fees by the elderly, 70 years and above. In other words, since the past 60 days, all elderly persons, 70 years and above have enjoyed the waiver of the 30 days mandatory waiting period as well as a waiver of the payment of fees and charges which was hitherto mandatory until the government’s
intervention. With this policy, all that a person 70 years and above needs is a Ghana Card to get enrolled onto the NHIS to enjoy instant care under the scheme.

In conclusion, the NHIS has a long way to go, and with the support of all it will get there