NHIS, E-Pharmacy set to combat illegal charges
The National Health Insurance Scheme (NHIS) is leveraging the Ghana National Electronic Pharmacy Platform (E-pharmacy) to combat illegal charges, commonly referred to as co-payments.
Co-payment in the context of the NHIS involves NHIA-credentialled facilities charging scheme members for services and medications paid for by the scheme.
The Chief Executive of the NHIA, Dr Da-Costa Aboagye, shared this information during a series of staff durbars held across the country, where he engaged with employees on enhancing the scheme and his welfare enhancement plans.
The most recent gathering took place last Friday at the Authority’s head office in Accra.
He appealed to all credentialled facilities and staff members to support his vision of eliminating illegal charges.
Dr Aboagye emphasised that ending this illegality was a shared responsibility, urging staff and other stakeholders to refrain from aiding such acts and to remain vigilant against facilities that perpetuate these practices.
He underscored the necessity of this effort for the sustainability of the scheme and the jobs of all staff members.
He indicated that co-payments represent a significant concern for the Authority and NHIS beneficiaries, as they often lead to unexpected out-of-pocket expenses for services and medications that are fully covered under the NHIS.
He noted that such practices created barriers to access and to undermine the core objective of the NHIS, which was to ensure equitable healthcare for all.
He reiterated that the NHIS covered diagnosis and treatment for 95 per cent of primary healthcare needs, and the NHIS expects that no member of the scheme will incur additional charges for these services and medications.
“Unfortunately, despite extensive efforts and awareness creation, illegal charges continue to persist, especially in the dispensing of prescribed medications to members.
“As part of my commitment to address this issue and enhance the performance of the scheme and health outcomes, the e-pharmacy policy is currently being integrated with the NHIS. It is currently being piloted in the regions of the North, with plans for a nationwide rollout to follow,” he said.
Elaborating on the E-pharmacy initiative, Dr Aboagye explained that the policy requires that if a credentialled pharmacy, whether within a healthcare facility or standalone, does not have a prescribed medication in stock, it must upload the prescription to the E-pharmacy platform.
“This enables the system to locate another credentialled facility within the member’s community that has the medication available, allowing the member or patient to be directed to that location for collection.
“Alternatively, with the assistance of the property addressing system, the medication can be delivered to the member at home in line with terms and conditions,” he said.
He said the E-pharmacy is currently being piloted in the regions of the North, with plans for a nationwide rollout soon.
He explained that the integration of this digital platform with the NHIS will significantly reduce opportunities for illegal charges on medications that should be covered because members can verify the availability of their medications in real-time, ensuring they are not pressured into making unauthorised payments.
“This move aligns with our mandate to protect beneficiaries and ensure that all services covered under the scheme remain free at the point of delivery,” he emphasized.
“This approach not only promotes collaboration among pharmacies but also ensures that patients can receive their medications without undue delay,” he said.
BY TIMES REPORTER
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