The National Health Insurance Authority (NHIA) is rolling out a range of digital systems and payment reforms aimed at improving accountability, expanding access to healthcare and strengthening the long-term sustainability of Ghana’s National Health Insurance Scheme (NHIS).
Chief Executive of the NHIA, Dr Victor Asare Bampoe, said the reforms include electronic claims processing, biometric verification, the One-Time Attendance Code (OTAC) system, data analytics and monthly payments to healthcare providers.
He also highlighted a new financing model being introduced under the government’s Free Primary Healthcare policy, which is designed to shift greater emphasis towards preventive and primary healthcare.
Dr Bampoe disclosed this in an interview with The Economist magazine, during which he outlined developments in Ghana’s health insurance system, efforts to address irregularities and measures to improve member confidence and the financial sustainability of the NHIS.
Dr Bampoe said the NHIS, established more than two decades ago to reduce out-of-pocket healthcare expenses, currently covers about 95 per cent of conditions treated at hospitals and clinics.
He said population coverage had increased from 58 per cent to 66 per cent within one year, with about 22 million people registered under the scheme in 2025.
According to him, active membership subsequently rose to 70 per cent as of August 2026, with the Authority targeting 80 per cent active coverage by the end of the year.
Dr Bampoe said digitalisation had become central to improving the administration, transparency and accountability of the NHIS.
He said all NHIS claims were now processed electronically, while a national digital health platform had been deployed in 502 healthcare facilities across eight regions.
The platform supports remote consultations and prescriptions through an electronic pharmacy system, which the NHIA says is intended to improve access to healthcare services.
The Authority has also introduced the One-Time Attendance Code system, which links each hospital visit to a unique code generated for a patient.
“We introduced a one-time code system that links each hospital visit to a unique code generated for the patient,” Dr Bampoe said.
He added that biometric verification was being used in high-volume facilities to authenticate patients and strengthen controls over the use of NHIS services.
The NHIA is also using data analytics to detect irregularities, including duplicate and potentially fraudulent claims across regions.
Dr Bampoe said the measures would help safeguard NHIS resources and ensure that payments were made only for genuine healthcare services.
The NHIA Chief Executive said the Authority had also improved its payment arrangements with healthcare providers, with facilities now receiving monthly payments for services provided to insured patients.
He said the arrangement provided healthcare facilities with greater financial predictability, allowing them to plan staffing levels and maintain consistent service delivery.
According to Dr Bampoe, predictable payments were critical to improving the efficiency and reliability of the health insurance system.
Dr Bampoe said the government’s Free Primary Healthcare policy was 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 was intended to encourage preventive and primary healthcare by giving providers an incentive to keep populations within their service areas healthy.
The policy forms part of broader efforts to strengthen primary healthcare and advance Universal Health Coverage (UHC).
On financing, Dr Bampoe said the NHIS was funded largely through a 2.5 per cent share of Value Added Tax (VAT), with more than 83 per cent of its funding linked to consumption taxes.
He said the government’s removal of the cap on the National Health Insurance Fund (NHIF) in 2025 had unlocked about US$300 million in additional resources.
While the additional funding had strengthened the Scheme, Dr Bampoe said the Authority was exploring new revenue streams and partnerships to improve its long-term sustainability, resilience and efficiency.
The NHIA CEO also highlighted the Ghana Medical Trust Fund, popularly known as MahamaCare, as a complementary intervention aimed at providing financial support for high-cost chronic diseases.
He said the Fund was designed to cover conditions that could place significant financial pressure on families, 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,” Dr Bampoe said.
He said the Fund would provide additional financial protection to families facing expensive and prolonged treatment.
Dr Bampoe said the combination of digital transformation, stronger claims controls, predictable provider payments, primary healthcare reforms, expanded membership and diversified financing was aimed at building a more sustainable NHIS.
He said the reforms would enable the Scheme to expand healthcare access while protecting public resources and strengthening confidence in Ghana’s health insurance system.
