The National Health Insurance Authority (NHIA) has commenced the partial implementation of revised service tariffs for credentialed healthcare providers, beginning with a 50 percent increase in current tariffs. The phased rollout started in August and is expected to reach full implementation by October 2026.
Chief Executive of the NHIA, Dr. Victor Asare Bampoe, explained that the decision to start with a partial increase was informed by evidence of significant claims leakages. He revealed that not less than 15 percent of claims currently paid may be ineligible, representing potential annual losses of about GH¢400 million. Without corrective measures, he warned, the Scheme’s financial exposure could rise to nearly GH¢1 billion annually.
“We must account for every reimbursed claim and ensure that resources are directed towards actual healthcare delivery,” Dr. Bampoe stressed.
Accountability Measures
The Authority has tied full deployment of the revised tariffs to the successful rollout of strict financial and accountability controls, including the One-Time Attendance Code (OTAC). OTAC is a digital claims management system designed to verify patient attendance and confirm service delivery before claims are processed.
Dr. Bampoe explained that OTAC will provide an additional layer of validation, reducing fraudulent practices, improving transparency, and ensuring NHIS funds are channelled toward genuine healthcare services. The system is currently being piloted in the Ahafo and Western North regions, with plans to extend to Oti and North East ahead of nationwide rollout.
Provider Confidence
Dr. Bampoe emphasized that the phased approach is not due to reluctance but a necessary safeguard to protect the Scheme’s sustainability. He assured healthcare providers that the tariff review was informed by a comprehensive nationwide stakeholder process and acknowledged their patience and constructive engagement.
He added that the reforms aim to strengthen collaboration between NHIA and healthcare facilities, improve provider confidence, and ensure NHIS members continue to access quality healthcare without financial barriers.
The partial implementation, he noted, provides an opportunity for the Authority to strengthen controls while gradually introducing the revised tariffs, ahead of full implementation in October.
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