The Membership and Regional Operations Director of the National Health Insurance Authority (NHIA), Mr. Sebastian Alagpulinsa, has embarked on a working visit to key health facilities and the NHIA Upper East Regional Office as part of efforts to strengthen healthcare delivery and improve the implementation of the National Health Insurance Scheme (NHIS) across the region.
Mr. Alagpulinsa was accompanied by the Deputy Director of Management Information Systems (MIS), *Mr. Samson Anim Ato, and the Upper East Regional Director of the NHIA, *Dr. Salifu Kombat.
The visit focused on assessing healthcare services delivered under the NHIS, monitoring operational performance, and engaging healthcare providers and NHIA staff on claims management, service delivery, and other critical issues affecting the efficient administration of the Scheme.
Ultimate Platz Hospital Raises Key Operational Concerns
As part of the tour, the delegation visited Ultimate Platz Hospital in Zuarugu, where they interacted with the hospital’s management and staff to assess the facility’s operations and its engagement with NHIS clients.
During the meeting, management highlighted several challenges affecting service delivery. These included delays in the submission and processing of claims, high claim deductions, and the increasing incidence of clients presenting invalid NHIS cards, which are detected by the Authority’s verification system.
The hospital further noted that a number of commonly prescribed medicines, including intravenous (IV) paracetamol, certain painkillers, and other essential medications, are currently not covered under the NHIS Medicines List. Consequently, patients are required to purchase these drugs out-of-pocket, often leading to dissatisfaction among clients who expect their NHIS membership to cover all prescribed treatments.
The Chief Executive Officer of Ultimate Platz Hospital, Dr. Abel Tuni, appealed for continued engagement between the NHIA and healthcare providers to address these concerns and improve patient satisfaction.
Hospital staff also raised operational issues relating to persistent network challenges affecting the generation of One-Time Passwords (OTPs), a key requirement for claims processing. They further sought clarification on claim deductions and other aspects of the claims management system.
Responding to the concerns, Mr. Alagpulinsa explained the operational framework of the NHIS claims processing system and encouraged healthcare workers to continuously build their capacity through regular training. He urged the hospital to make full use of technical support and training opportunities provided by the NHIA’s Claims Processing Centre (CPC) to improve claims accuracy, minimize errors, and enhance operational efficiency.
The Hospital Administrator expressed gratitude to the NHIA delegation from both the Head Office and the Upper East Regional Office, describing the visit as a clear demonstration of the Authority’s commitment to supporting healthcare providers and strengthening the implementation of the NHIS. He reaffirmed the hospital’s commitment to partnering with the NHIA in delivering quality healthcare services to insured clients.
Engagement with NHIA Upper East Regional Staff
The delegation also met with staff of the NHIA Upper East Regional Office at the Regional Conference Hall in Bolgatanga, where they held an open and interactive discussion on the Authority’s regional programme of work and operational challenges confronting staff.
During the engagement, staff raised concerns about illegal co-payments and unauthorized charges being demanded by some healthcare providers, post-credentialing issues, and medication-related challenges affecting effective service delivery under the NHIS.
Addressing the gathering, Mr. Alagpulinsa emphasized the importance of continuous professional development and encouraged staff to stay updated on NHIS policies, reforms, and operational guidelines. According to him, a well-informed workforce is better positioned to educate stakeholders, monitor accredited healthcare providers, and promptly identify and address cases of non-compliance within the Scheme.
He reiterated the Authority’s commitment to strengthening collaboration with healthcare providers while improving claims management systems and enhancing healthcare services for NHIS members across the country.
The working visit forms part of the NHIA’s broader strategy to deepen stakeholder engagement, address operational bottlenecks, and ensure the efficient delivery of quality healthcare services under Ghana’s National Health Insurance Scheme.
Source: MyBlueWavesOnline.com
By: Maurice Duncan | Public Relations Manager, NHIA Upper East Region | Bolgatanga
