By Love Wilhelmina Abanonave
Deputy Chief Executive Officer of Operations at the National Health Insurance Authority (NHIA), Dr. Senanu Kwesi Djokoto has stated that the free primary healthcare introduced by President Mahama will ease financial and operational pressure on the National Health Insurance Scheme (NHIS).
He noted that when basic health services are provided to citizens at no cost at the point of access, it reduces the number of claims the scheme has to process and pay, thereby cutting costs and improving sustainability.
“Free primary healthcare reduces the burden in the National Health Insurance Scheme,” the Deputy CEO of Operations stated today on the GTV breakfast show.
The free primary healthcare covers essential services such as treatment of malaria, diarrhea, respiratory infections, maternal and child health services, immunizations, and management of minor injuries.
These conditions account for a significant share of outpatient visits at health facilities across the country, and subsequently make up a large portion of NHIS claims.
According to the NHIA, the current financing model requires the Authority to reimburse accredited providers for services rendered to active members. High volumes of primary-level cases translate into increased claims, longer processing times, and delayed reimbursements.
By removing user fees for primary care through direct government funding or other arrangements, the frequency and value of claims submitted to the NHIS would decline.
The Deputy CEO explained that such a shift would allow the NHIS to focus its resources on secondary and tertiary care, which are typically more expensive and complex to treat. “If we take care of primary care through a free access model, the scheme can better manage catastrophic and specialist cases without overstretching the fund,” he said.
Discussions on financing mechanisms and service delivery arrangements are ongoing among stakeholders, including the Ministry of Health, Ministry of Finance, and development partners.
The NHIA has in recent years faced challenges with funding gaps, claims arrears, and rising healthcare costs. The Authority’s leadership has been exploring reforms to improve efficiency, including digital claims processing, capitation pilots, and preventive health programs.
