The National Health Insurance Authority (NHIA) has commenced the partial implementation of revised National Health Insurance Scheme (NHIS) service tariffs for credentialed healthcare providers, beginning with a 50 percent increase in current service tariffs as part of a broader effort to improve provider reimbursement nationwide.
The partial implementation started in August 2026, marking the beginning of a phased rollout of the revised tariffs, with full implementation expected to be completed by October this year.
The Authority explained that the tariff adjustment followed a comprehensive, all-inclusive nationwide stakeholder review process involving healthcare providers and other key players in the health insurance system.
According to the NHIA, the upward review forms part of ongoing measures to improve provider reimbursement by ensuring that payments better reflect the prevailing cost of delivering healthcare services across the country.
The adjustment is intended to address longstanding concerns from healthcare providers that existing tariffs have not kept pace with the actual expenses involved in running health facilities.
Chief Executive of the NHIA, Dr Victor Asare Bampoe, explained that the decision to begin with a partial implementation of the 50 percent increase was informed by anecdotal evidence suggesting that not less than 15 percent of claims currently paid may be ineligible, representing approximately GH¢400 million in potential losses annually.
He warned that if existing leakages in the system continued unaddressed and the full tariff increase was implemented without corrective measures in place, the financial exposure of the Scheme could rise to nearly GH¢1 billion annually, posing a significant threat to the long-term sustainability of the NHIS.
He explained that this evidence made it necessary for government, as the payer, to demand the introduction of strict financial and accountability controls to seal existing leakages before the full implementation of the revised tariffs could proceed.
OTAC System Central to Accountability Reforms
Dr Bampoe said a major component of the implementation process is the deployment of the One-Time Attendance Code (OTAC), a digital claims management intervention designed to strengthen verification and accountability within the NHIS payment system.
He explained that the OTAC system would provide an additional layer of validation by confirming patient attendance and verifying that healthcare services were actually delivered before claims are processed and reimbursed, a measure expected to significantly reduce fraudulent practices within the scheme.
“We must account for every reimbursed claim and ensure that resources are directed towards actual healthcare delivery.”
Dr Victor Asare Bampoe
He said the system is expected to reduce claims leakages, improve transparency, minimise fraudulent practices, and ensure that NHIS funds are channelled toward genuine healthcare delivery rather than being lost to ineligible or fraudulent claims.
Dr Bampoe explained that the introduction of OTAC alongside the tariff increase has become necessary to ensure that additional payments to healthcare providers translate into improved services for NHIS members, while simultaneously protecting the financial integrity of the Scheme as a whole.
He stressed that implementing the full tariff increase without the necessary accountability measures in place would expose the Scheme to inefficiencies that could ultimately undermine its sustainability, reinforcing the rationale behind the Authority’s phased approach to the rollout.
Deliberate, Not Reluctant, Rollout Strategy
Dr Bampoe was keen to clarify that the phased approach to implementation was not due to any reluctance on the part of the Authority to introduce the full increase, but rather a necessary measure to ensure that adequate systems and safeguards were properly in place before the full additional financial commitment was introduced.
He explained that the partial implementation, which began in August, provides the Authority with an opportunity to continue strengthening the necessary controls while gradually introducing the revised tariffs, ahead of the expected full rollout by October 2026.
Providing further detail on the OTAC rollout, Dr Bampoe said the system is currently being piloted in the Ahafo and Western North Regions, where the Authority is actively assessing its effectiveness and gathering feedback from both healthcare providers and NHIS members ahead of a planned nationwide rollout.
He added that additional regions earmarked for the pilot phase include Western North, Oti, and Northeast Regions, before the system is eventually extended nationwide as part of the broader tariff reform process.
Authority Commends Provider Patience Amid Reforms
Dr Bampoe acknowledged the important contribution of both private and public healthcare providers to Ghana’s healthcare delivery system, expressing appreciation for their patience and constructive engagement throughout the tariff review process.
“The Authority recognised the important contribution of private and public healthcare providers to Ghana’s healthcare delivery system and appreciated their patience and constructive engagement throughout the tariff review process.”
Dr Victor Asare Bampoe
He reaffirmed that the NHIA remains committed to improving relationships with healthcare providers while ensuring that resources allocated to the Scheme are used efficiently and responsibly, positioning the phased tariff rollout as part of a broader strategy to strengthen both provider confidence and the long-term financial health of Ghana’s national health insurance system as it moves toward full implementation by October 2026.
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