Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Nsiah-Boateng, Eric; Asenso-Boadi, Francis; Dsane-Selby, Lydia; Andoh-Adjei, Francis-Xavier; Otoo, Nathaniel; Akweongo, Patricia

doi:10.1186/s12913-017-2054-1

Cited by 15 publications

(23 citation statements)

References 11 publications

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“…The main source of routinely collected health data is from largely public (and some private) service providers such as NHIS claims and the DHIMS 2. NHIS claims are recordedthe current proportion of electronic claims is 25% (4th quarter 2019; personal communication, Dsane-Selby)the rest are paper based [52]. There are annual NHIS reports but there is some delay in making these available online [12].…”

Section: Health Services Usementioning

confidence: 99%

“…Much of the data described in this paper are derived from governmentsponsored information systems and census surveys, where statistics are reported to be systematically exaggerated across Africa [24,[71][72][73]. We did not assess the quality of the data sources in this paper but there are promising quality assurance processes to ensure data integrity for some sources [27,30,52]. A more comprehensive consideration of quality could be pursued in future studies.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana

Hollingworth

Downey

Ruiz

et al. 2020

Health Res Policy Sys

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Introduction Health technology assessment (HTA) is an effective tool to support priority setting and generate evidence for decision making especially en route to achieving universal health coverage (UHC). We assessed the capacity needs, policy areas of demand, and perspectives of key stakeholders for evidence-informed decision making in Nigeria where HTA is still new. Methods We surveyed 31 participants including decision makers, policy makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations. We revised an existing survey to qualitatively examine the need, policy areas of demand, and perspectives of stakeholders on HTA. We then analyzed responses and explored key themes. Results Most respondents were associated with organizations that generated or facilitated health services research. Research institutes highlighted their ability to provide expertise and skills for HTA research but some respondents noted a lack of human capacity for HTA. HTA was considered an important and valuable priority-setting tool with a key role in the design of health bene ts packages, clinical guideline development, and service improvement. Public health programs, medicines and vaccines were the three main technology types that would especially bene t from the application of HTA. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents needed evidence on health system nancing, health service provision, burden of disease and noted a need for training support in research methodology, HTA and data management Conclusion The use of HTA by policymakers and communities in Nigeria is very limited mainly due to inadequate and insu cient capacity to produce and use HTA. Developing sustainable and institutionalized HTA systems requires in-country expertise and active participation from a range of stakeholders. Stakeholder participation in identifying HTA topics and conducting relevant research will enhance the use of HTA evidence produced for decision making. Therefore, the identi ed training needs for HTA and possible research topics should be considered a priority in establishing HTA for evidenceinformed policy making for achieving UHC particularly among the most vulnerable people in Nigeria.

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Section: Health Services Usementioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana

Hollingworth

Downey

Ruiz

et al. 2020

Health Res Policy Sys

Self Cite

View full text Add to dashboard Cite

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“…The lack of funds in facilities was a result of the delay in payments by the NHIS, partly caused by the claims process and to some extent the lack of adequate funds for the scheme. The establishment of the electronic claims submission system by the NHIS is a step in the right direction as this will reduce fraud and abuse, help contain costs and promote the financial sustainability of the NHIS [ 27 , 28 ]. The system also allows for the early settlement of claims, thereby encouraging them to continue to provide services to clients of the NHIS.…”

Section: Main Textmentioning

confidence: 99%

The implementation of the free maternal health policy in rural Northern Ghana: synthesised results and lessons learnt

2018

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ObjectiveA free maternal health policy was implemented under Ghana’s National Health Insurance Scheme to promote the use of maternal health services. Under the policy, women are entitled to free services throughout pregnancy and at childbirth. A mixed methods study involving women, providers and insurance managers was carried out in the Kassena-Nankana municipality of Ghana. It explored the affordability, availability, acceptability and quality of services. In this manuscript, we present synthesised results categorised as facilitators and barriers to access as well as lessons learnt (implications).ResultsReasonable waiting times, cleanliness of facilities as well as good interpersonal relationships with providers were the facilitators to access. Barriers included out of pocket payments, lack of, or inadequate supply of drugs and commodities, equipment, water, electricity and emergency transport. Four lessons (implications) were identified. Firstly, out of pocket payments persisted. Secondly, the health system was not strengthened before implementing the free maternal health policy. Thirdly, lower level facilities were poorly resourced. Finally, the lack of essential inputs and infrastructure affected quality of care and therefore, access to care. It is suggested that the Government of Ghana, the Health Insurance Scheme and other stakeholders improve the provision of resources to facilities.

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“…Drug utilization research could therefore be of benefit to NHIA through a better understanding of the factors influencing drug prescribing, dispensing and consumption by patients. Also, while the NHIS claims database has been reviewed for health services’ research, there are currently no published reviews to guide the application of this database for DUR. Therefore, this MiniReview will serve as a helpful guide to understanding the possibilities and limitations for the use of the NHIS claims database for DUR.…”

Section: Introductionmentioning

confidence: 99%

A review of the Ghana National Health Insurance Scheme claims database: possibilities and limits for drug utilization research

Ankrah

Hallas

Odei

et al. 2018

Basic Clin Pharma Tox

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Background There are inadequate data on prescribed drug utilization in Sub‐Saharan Africa (SSA). Drug utilization research (DUR) in this region is hampered by lack of access to databases that capture prescribed drug utilization such as health insurance claims, electronic medical records and disease registries. The primary objective of this MiniReview was to describe the content of the NHIS claims database in the context of the health care system in Ghana. We will also review the possibilities and limitations of analysing this novel database for drug utilization research (DUR) in Ghana. Methods We reviewed the history, composition of the database, coverage and health systems in Ghana. To demonstrate the application of the NHIS claims database for DUR, we reviewed the NHIS’ drug formulary (NHIS medicines’ list), assessed and quantified the utilization of the top 25 most commonly prescribed medicines and their distributions by age, sex, region of residence and by MDCs. Results As of December 2014, about 40% (~10.5 million) of the Ghanaian population were active beneficiaries of NHIS. There were 1.43 million unique patients in the NHIS claims database who received services from about 81 providers located in 9 out of the 10 regions in Ghana. The mean age of this sample of beneficiaries was 31 (standard deviation, 22) years, a third of whom were aged <18 years old. Nearly, 2 out of every 3 beneficiaries were females. On average, there were approximately 3 outpatient visits per beneficiary in 2015. There were about 522 unique drugs on the NHIS medicine list. Overall, analgesic was the most prescribed class of medicine (mostly paracetamol and diclofenac). Antimalarials, artemether‐lumefantrine, were observed as the second most prescribed medicines followed by anti‐infectives (metronidazole) and antihypertensives (amlodipine). Conclusion The Ghana NHIS claims database is a great resource for DUR. This database could also be extended to facilitate pharmacoepidemiological and other health services’ research especially if transformed into one of the existing standardized common data models.

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Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Cited by 15 publications

References 11 publications

What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana

What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana

The implementation of the free maternal health policy in rural Northern Ghana: synthesised results and lessons learnt

A review of the Ghana National Health Insurance Scheme claims database: possibilities and limits for drug utilization research

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