The National Health Insurance Authority (NHIA) has urged Parliament’s Health Committee to support the amendment of the Health Insurance Act, 2012 (Act 852), to provide a legal framework for the implementation of the government’s Free Primary Healthcare initiative and population-based payment methods.

The Authority says revising the law would also help address operational challenges, including claims leakages, illegal co-payments and the mismatch between healthcare tariffs and the funding capacity of the National Health Insurance Scheme (NHIS).

Deputy Chief Executive Officer in charge of Operations at the NHIA, Dr Kwesi Djokoto, made the appeal when the Health Committee paid a working visit to the Authority on Monday, October 12.

He said the proposed amendment was necessary to ensure that the existing legal framework reflected new approaches to healthcare financing and service delivery.

Dr Djokoto explained that the Ministry of Health was already working on the amendment and called on the committee to help prioritise the process.

“The legal framework is something that has to be modified to accommodate the Free Primary Healthcare and the population-based payment methods,” he said.

He added that the Authority needed stronger legal backing to improve its operations and strengthen measures to prevent fraud and illegal payments within the health insurance system.

NHIA identifies claims leakages, illegal co-payments

Dr Djokoto listed claims leakages, illegal co-payments and the adequacy of tariffs relative to the scheme’s available funding as some of the major challenges confronting the Authority.

He said the NHIA was taking steps to address these concerns through digital interventions, a review of tariffs and the establishment of an anti-fraud and illegal payments directorate.

The measures, he explained, were intended to help the Authority prevent and detect fraudulent claims and unauthorised charges, while ensuring that those responsible faced appropriate sanctions.

The proposed strengthening of sanctions, he said, would serve as a deterrent to healthcare providers and other actors who engage in fraudulent practices or demand illegal payments from insured patients.

Dr Djokoto said the Authority was responding through the tariff reset and the establishment of the dedicated directorate to strengthen its ability to identify and address such practices.

He called on the Health Committee to support efforts to strengthen sanctions for fraud and illegal co-payments as part of broader measures to improve accountability and protect the integrity of the scheme.

NHIA seeks support for 2027 capital budget

Dr Djokoto further appealed to the committee to support capital budget funding for 2027, saying the Authority had infrastructure in place to support its operations but required continued investment to strengthen its systems.

He said the NHIA was also using digital interventions to improve the administration of the scheme and the processing of claims.

According to him, claims were now processed electronically, with a turnaround time of 20 days, while payments to healthcare providers were being made monthly.

“Claims are fully electronic, with a 20-day turnaround time; we are paying monthly. We have digital interventions to enhance the work of the National Health Insurance Authority,” he said.

Dr Djokoto urged the committee to support the proposed amendment of Act 852, stronger sanctions against fraudulent practices and illegal co-payments, and capital funding for 2027.

The proposed changes are expected to provide the legal backing needed to accommodate Free Primary Healthcare and population-based payment methods, while addressing some of the operational difficulties affecting the NHIA’s work.