Medical Superintendents Group of Ghana has raised concerns over disruptions in claims submissions following the transition to the Ghana Health Information Management System (GHIMS), while also calling for a review of National Health Insurance Scheme (NHIS) tariffs to reflect rising healthcare delivery costs.
The concerns were presented during a working visit by the Group’s newly elected executives to the National Health Insurance Authority (NHIA) Head Office in Accra, where they met the Authority’s Executive Management to discuss challenges affecting healthcare providers and to strengthen collaboration under the National Health Insurance Scheme.
The meeting comes at a critical period for Ghana’s healthcare system as providers continue to adjust to a new claims management platform while grappling with increasing operational costs.
Although the NHIA has recently improved the timeliness of claims reimbursements, healthcare facility managers say challenges linked to the migration from the Lightwave Health Information Management System (LHIMS) to GHIMS have affected claims processing in some facilities, creating financial and operational pressures.
President of the Medical Superintendents’ Group of Ghana, Dr. Eric Sarpong-Ntiamoah, commended the NHIA for the recent payment of claims to healthcare providers, noting that the reimbursements had helped facilities maintain service delivery across the country.
“We appreciate the efforts of the NHIA in ensuring timely reimbursement of claims. These payments have enabled health facilities to continue providing quality healthcare services to Ghanaians”.
President of the Medical Superintendents’ Group of Ghana, Dr. Eric Sarpong-Ntiamoah
Despite the progress, Dr. Sarpong-Ntiamoah explained that some healthcare facilities experienced difficulties during the transition from LHIMS to GHIMS, affecting their ability to submit claims for services rendered during certain periods.
According to him, the disruptions created challenges for healthcare providers that rely heavily on reimbursements from the NHIS to sustain their operations. He appealed to the Authority to consider measures that could support affected facilities while efforts continue to resolve the challenges.
He also sought updates on the implementation of the long-awaited review of NHIS tariffs, arguing that increasing costs of medicines, medical supplies and general healthcare delivery have made tariff adjustments necessary.
NHIA Promises Urgent Action
Responding to the concerns, Chief Executive of the NHIA, Dr. Victor Asare Bampoe, acknowledged the difficulties encountered during the migration process and assured the Group that the Authority had been engaging relevant stakeholders to identify a solution.
He revealed that the NHIA had explored the possibility of making payments to affected facilities based on their average historical claims and had obtained approval from the Authority’s Governing Board to proceed with the proposal.
However, further consultations with the Ministry of Health and the Ministry of Finance indicated that such payments would not be permissible under existing Public Financial Management regulations because they would not be backed by evidence of actual services rendered
“We explored every available option because we understand the challenges providers are facing. However, we must ensure that any intervention complies with the Public Financial Management regulations. We will continue to engage the appropriate authorities to find a workable solution.”
Chief Executive of the NHIA, Dr. Victor Asare Bampoe
Dr. Bampoe stressed that while the NHIA remains committed to supporting healthcare providers, the Authority must operate within the country’s legal and financial framework to ensure transparency and accountability in the use of public funds.
Complying with Public Financial Regulations
The Deputy Chief Executive for Finance and Investment, Madam Anatu Anne Seidu Bogobiri, also underscored the importance of adhering to financial regulations.
She explained that the Authority recognizes the concerns of healthcare providers but can only process payments based on verified claims supported by evidence of services delivered to NHIS members:“Payments under the Scheme must be supported by verifiable claims in line with existing financial regulations.”.
The issue of NHIS tariff adjustments also featured prominently during the discussions. Deputy Chief Executive for Operations, Dr. Kwesi Senanu Djokoto, assured the medical superintendents that the Authority was making progress toward reviewing the tariffs.
According to him, stakeholder consultations have already been undertaken and a draft proposal has been developed. The proposal is currently undergoing the required approval processes before implementation.
Dr. Djokoto acknowledged the financial pressures facing healthcare providers and said the Authority appreciates the impact of inflation and rising operational costs on healthcare delivery.
“We recognize the concerns being raised by providers and understand the effect of increasing operational costs. Work is progressing steadily to secure the necessary approvals for a tariff review”.
Deputy Chief Executive for Operations, Dr. Kwesi Senanu Djokoto
He further disclosed that efforts are ongoing to improve the performance and stability of the GHIMS platform to facilitate smoother claims submission and processing.
GHIMS as Part of Broader Efforts to Modernize Healthcare Information Management
The introduction of GHIMS forms part of broader efforts to modernize healthcare information management and strengthen the efficiency of claims administration under the NHIS.
However, healthcare managers have repeatedly emphasized the need for a seamless transition process to prevent disruptions that could affect healthcare financing and service delivery.
Throughout the engagement, both parties emphasized the importance of sustained collaboration in addressing challenges within the health insurance system and ensuring that healthcare providers remain adequately supported.
The NHIA management reaffirmed its commitment to working closely with healthcare providers and other stakeholders to improve claims management, strengthen healthcare financing and enhance access to quality healthcare services for NHIS members across the country.
The meeting ended with a shared commitment to continued dialogue, with both the NHIA and the Medical Superintendents’ Group agreeing that stronger partnerships and practical solutions will be essential to sustaining healthcare delivery and advancing universal health coverage in Ghana.
For healthcare providers navigating the transition to a new digital claims system and awaiting revised tariffs, the discussions offered reassurance that their concerns are being heard—even as the search for lasting solutions continues.
