A specialist group of clinical experts drawn from various health institutions on March 12, 2024, met at the AH Hotel, East Legon, in Accra for a comprehensive review of the Ghana Diagnostic Related Groupings (G- DRG) payment method of the National Health Insurance Scheme (NHIS).

As a follow-up to a preliminary stakeholder meeting in December 2023, this three-day hands-on event was organized by the Strategic Health Purchasing Directorate (SHPD) of the National Health Insurance Authority (NHIA), Head Office.

The clinical experts were drawn from all specialty areas that are on the Benefit Package of the Scheme and were from the Ghana Health Service (GHS), Korle Bu Teaching Hospital, Komfo Anokye Teaching Hospital, Greater Accra Regional Hospital, Upper East Regional Hospital, Police Hospital, Ho Regional Hospital, Bank Hospital, Ghana Infectious Disease Centre, Society of Private Medical and Dental Practitioners, Accra Medical Centre, University of Cape Coast Hospital, Accra Psychiatric Hospital, Private Health Facilities Association of Ghana, Medicas Hospital, National Blood Service, Shai-Osudoku District Hospital, Fresh Luk Eye Centre and St. Joseph Hospital.

The opening ceremony was chaired by a member of the NHIA Governing Board, Dr. Isaac Charles Noble Morrison who called for a collective responsibility to ensure an all-inclusive NHIS.

He said the ongoing meetings were a statutory requirement in line with the NHIA Act 2012, (Act 852) section 34 subsection 1, which mandates the Authority to review the NHIS service list and service tariff in collaboration with healthcare providers.

The Convener, Acting Director, Strategic Health Purchasing Directorate (SPHD), Dr. Ruby Aileen Mensah Annan (Mrs.) gave an overview of the scheme’s operations and the development and use of G-DRGs as the payment method for services under the Scheme.

She said the NHIA remains committed to achieving the objective of providing financial risk protection against the cost of quality healthcare services for its members. She emphasised the need for the expert team to capture all the needed inputs for care to ensure the development of accurate reimbursable tariffs.

The Ag. Director, NHIA Actuarial Directorate, Mr. Magnus Owusu-Agyemang made a presentation on principles of averages and the actuarial science of health and how it is applied in tariff development. Ag. Director, Claims, Dr. Abigail Derkyi-Kwarteng walked the participants through Claims observations on the G-DRG implementation.

The Director, Financial Accounting of the NHIA Finance Directorate, Dr. Gustav Cruickshank,
shed light on the NHIA payment flow for Claims and a representative of the NHIA Quality Assurance Directorate, Mr. Eugene Segbefia, made a presentation on Clinical Audit findings on the G-DRG implementation.

The Director in charge of Research, Policy, Monitoring and Evaluation, Dr. Francis Asenso-Boadi extemporaneously communicated the monitoring and evaluation findings on the G-DRG implementation.

As Chairman of the NHIA National Copayments Committee, Dr. Francis Asenso-Boadi decried the recurrent problem of illegal charges (copayments) by some credentialed healthcare providers.

The NHIS service tariff review consultant, Professor Adukwei Hesse, highlighted the guidelines for the specialty group work, review templates, reference materials and the specialty groups and urged the participants to provide solutions to concerns raised to inform the final decision of policy makers regarding the 2024 NHIS service tariff review.