NHIA effects 26% increase in provider tariffs

The National Health Insurance Authority (NHIA) has reviewed upwards provider tariffs for medical services provided under the Scheme. The announcement by the Chief Executive of the NHIA, Sylvester A. Mensah comes as a relief to many health service providers – hospitals and other health centres – after concerns that cost of health care provision has increased.

The 26% tariff increase to take effect from February 1st, 2013 was revealed at a short ceremony on Tuesday.

According to him, “it is projected that the modifications and inclusions to the G-DRG structure will result in a 26% increase in tariffs” and that the “review process has resulted in a number of key changes in the existing Ghana Diagnostic Related Groupings (G-DRG) structure.”

The G-DRG is a payment method in health insurance where, related diagnoses are grouped together and the average cost of treatment in that group determined. Health service providers are therefore paid according to the diagnosis they give their clients.

Over the years, the providers have complained that the fee paid them by the NHIS was not consistent with price changes on the market. Following several appeals from the providers, the NHIS embarked on a review of the fees. The review which in itself is considered a highly technical endeavour, according to the Chief Executive was done with assistance from a group of experts and consultants in collaboration with health specialists and physicians in tertiary, secondary and primary hospitals.

Further to the general upward adjustments, Mr Mensah said G-DRGs and tariffs have been developed for the following procedures: Outpatient physiotherapy, cataract surgery with lens implant (including the cost of intraocular lens), CT Scan and MRI, chemotherapy and radiotherapy.

Tuesday’s announcement was preceded by a comprehensive nationwide training session for healthcare providers, representatives of professional associations and scheme staff on the review to ensure a thorough understanding of the changes in order to guarantee a smooth implementation of the new tariff regime.

Mr Mensah appreciated “the patience and support exhibited by all providers and stakeholders during the review process.”