NHIA Deploys Digital Reforms- Dr Asare-Bampoe

The National Health Insurance Authority (NHIA) is deploying digital systems and payment reforms to strengthen accountability, improve access to healthcare and make the National Health Insurance Scheme (NHIS) sustainable.

Chief Executive of the Authority, Dr Victor Asare-Bampoe, said the reforms include electronic claims processing, biometric verification, a One-Time Attendance Code (OTAC) system, data analytics, monthly payments to healthcare providers, and a new financing approach under the government’s Free Primary Healthcare policy.

He made the disclosure in an interview with The Economist magazine, where he outlined developments in Ghana’s health insurance system and efforts to expand coverage, address irregularities, enhance member confidence and improve sustainability.

Dr Asare-Bampoe said the NHIS, established more than two decades ago to reduce out-of-pocket healthcare costs, currently covers about 95 per cent of conditions treated at hospitals and clinics.

He said the Scheme expanded its population coverage from 58 per cent to 66 per cent within one year, reaching about 22 million registered members in 2025, while active membership had subsequently increased to 70 per cent as of August 2026, with the Authority targeting 80 per cent active coverage by the end of the year.

He said digitalisation has become central to improving the administration and accountability of the NHIS. According to him, all NHIS claims are processed electronically, while a national digital health platform has been deployed across 502 healthcare facilities in eight regions.

The platform enables remote consultations and prescriptions through an electronic pharmacy system.

The Authority has also introduced a One-Time Attendance Code system that links each hospital visit to a unique code generated for the patient. “We introduced a one-time code system that links each hospital visit to a unique code generated for the patient,” he said.

Biometric verification is also being used in high-volume facilities to authenticate patients and strengthen controls around the use of NHIS services, while data analytics is being used to identify irregularities, including duplicate and potentially false claims.

Dr Asare-Bampoe said the Authority has improved its payment arrangements with healthcare providers, with facilities now receiving monthly payments for services delivered to insured patients.

He said the arrangement gives providers greater financial predictability, enabling them to plan staffing levels and maintain consistent service delivery.

He said the government’s Free Primary Healthcare policy is also introducing a different approach to financing healthcare providers. “Under the Free Primary Healthcare policy, the programme pays providers based on the number of people in a defined service area instead of paying per treatment,” he explained.

He said the model is intended to encourage preventive and primary healthcare by giving providers an incentive to keep populations within their service areas healthy.

On financing and sustainability, he said the NHIS is funded largely through a 2.5 per cent share of Value Added Tax, with more than 83 per cent of its funding tied to consumption taxes, and that the government’s removal of the cap on the National Health Insurance Fund in 2025 unlocked about 300 million dollars in additional resources.

He also highlighted the Ghana Medical Trust Fund, popularly known as MahamaCare, as a complement to the NHIS in addressing high-cost chronic diseases, including cancer, stroke and heart disease, which together account for about 42 per cent of deaths in Ghana.

“Studies in Ghana have shown that usually, when someone has a chronic disease, within a year or less, the family of the person is in penury,” he said.

Dr Asare-Bampoe said the combination of digital transformation, stronger claims controls, predictable provider payments, primary healthcare reforms, expanded membership and diversified financing aims to build a more sustainable NHIS capable of expanding access while protecting public resources.

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