The National Health Insurance Authority (NHIA) will from next 2023 add the treatment and medication for prostate cancer to the number of cancers treated free under the scheme.
This is after the completion of actuarial studies conducted by the scheme proved its feasibility and practicality and is concluding with other final touches for takeoff.
The Chief Executive of the NHIA, Dr Bernard Okoe-Boye, announced this when the board and management called on President Nana Addo Dankwa Akufo-Addo for him to sign some of the new policies to take effect and briefed him about the work of the scheme at the Jubilee House in Accra.
He indicated that at the end of January 2017, childhood cancers were not on the scheme, however, recently, four childhood cancers, which constituted 80 per cent of all childhood cancers in Ghana, were added and covered by the national health insurance scheme.
He indicated that Herceptin, a very important drug for breast cancer treatment, had now been added to the regime while hydroxyurea, a very effective drug that helped Sickle Cell patients to live high quality life had also been added.
Claims
Dr Okoe-Boye said as of 2017, there had been over one year arrears payments which was over GH¢1billion, but stated that the arrears had been reduced to eight months, meaning when the three months processing and vetting time were deducted, it would be left with about four or five months.
He said five months was a healthy one compared to the past, but was sure that with the way the scheme was working, it could clear all the areas within the shortest possible time.
Challenges
Touching on some of the challenges facing the scheme, he explained that the processing fees of GH¢6 and premium of GH¢25 were instituted over 17 years ago and at times the scheme spent more in processing.
He added that those who were not SSNIT contributors had their premium at GH¢26 and it had been so for 16years and needed to be reviewed.
Illegal charges
Concerning illegal charges, also referred to as co-payment, he announced that the board had taken steps in identifying the problem and the factors that informed the practice which included claims by facilities that the tariffs were not realistic.
The scheme quickly reviewed upwards the agreed 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.
Briefing the President, Dr Okoe-Boye said the scheme had moved from one-year arrears to five months and had been paying an average of GH¢100 million every month to providers, making GH¢1.2billion a year.
False claims
Dr Okoe-Boye told the President that the scheme would from next year be undertaking biometric verification at the various facilities so that when holders of the card accessed facilities under the NHIS, their particulars would be captured to make it difficult for false claims.
He said those caught cheating would not be allowed to work with the NHIS.
President Akufo-Addo described the biometric verification of patients as a very important step to make claims verifiable and in real time.