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NHIA increases payments for medicines, services

BY: Donald Ato Dapatem
Dr Bernard Okoe Boye - Chief Executive of the NHIA
Dr Bernard Okoe Boye - Chief Executive of the NHIA

The National Health Insurance Authority (NHIA) has reviewed upwards the agreed 2020 increment of medicine and service tariffs for service providers by 30 per cent effective July 1, 2022.

This was after the scheme and stakeholders undertook a market survey of prices and agreed on the figure largely on the basis of inflation and some other variables.

The Chief Executive of the NHIA, Dr Bernard Okoe Boye, disclosed this to the Daily Graphic in an interview in Accra yesterday[July 4, 2022].

He said the increment, which had been communicated to service providers, would halt co-payment and illegal collection.

He explained that the last time a review was done was about five years ago, but that the scheme realised that the charges were unrealistic so about two years ago, together with stakeholders, a scientific review of the prices was done to reflect current prices.

Using paracetamol as an example, he said if the current market price was GH¢2 and higher than what the NHIS would pay, the service provider would prescribe the medicine but would not dispense it to the patient to avoid making losses.

“Some would tell you that they do not have the medicine so you should go and buy it outside their facility. Others would find a way to let you buy from them although the medicine was captured in the agreed list,” he explained.

The reviewed medicines and tariffs include treatment of the newly added four childhood cancers, clinical family planning services, hydroxyurea for sickle cell anaemia, and other new formulations.

A statement issued by the NHIA explained that the review was in accordance with the National Health Insurance Act 852, (Act 2012) .

It said the latest development was done in consultation with the NHIA credentialled healthcare service providers and other critical stakeholders in the health sector.

Per the mandate of the NHIA, the reviews are done periodically following a very rigorous scientific process.

WHO

The current reviewed Medicines List contains a total of 546 formulations.

The statement said a national survey of medicine prices was undertaken using the methodology of the World Health Organisation (WHO) and the Health Action International (HAI).

“Pricing data was collected from manufacturers, wholesale distributors, private pharmacies, government, mission, and private health facilities located in all the 16 regions in the country. The output of the Framework Contract Agreement of the Ministry of Health was also factored into the pricing of the formulations within the contract arrangement,” it added.

It said the prices provided were those agreed upon by the NHIA and stakeholders as the reimbursable price for medicines supplied under the scheme, and showed a 30 per cent increment of the data collected.

Commission

It explained that the NHIA Board commissioned a multi-stakeholder team to conduct a costing exercise of healthcare services that would inform the next service tariff review and that the output of the costing exercise was used to determine reviewed tariff rates.

The statement said in line with standard practice, all key stakeholders were involved in the process of review and that the average impact of the service tariffs, across all provider types in the public sector was about a 35 per cent increment from the previous service tariffs.

It explained that these adjustments had been made in consultation with all stakeholders, taking into consideration all economic indices and “these considerations will improve the availability of all medicines on the NHIS medicine list nationwide. Furthermore, it is expected to minimise out-of-pocket payments (unauthorised fees) charged to NHIS members at the point of healthcare delivery and increase the public’s confidence in the Scheme”.