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. 2022 May 9;12(5):e054757.
doi: 10.1136/bmjopen-2021-054757.

Benefit-cost analysis of electronic claims processing under Ghana's National Health Insurance Scheme

Justice Nonvignon  1 , Rebecca Addo  2 , Huihui Wang  3 , Anthony Seddoh  4
Affiliations

Benefit-cost analysis of electronic claims processing under Ghana's National Health Insurance Scheme

Justice Nonvignon et al. BMJ Open. .

Abstract

Objective: The aim of this study was to evaluate the benefit-cost of E-claims. A benefit-cost analysis was used to evaluate the efficiency of E-claims from the perspective of the providers and the purchaser.

Design: A benefit-cost analysis approach was taken for this economic evaluation. Furthermore, we estimated the incremental benefit-cost ratio (IBCR) of the intervention under assessment.

Participants: Purchasers and healthcare providers of the National Health Insurance Scheme (NHIS) of Ghana were the study population.

Results: The analysis was stratified according to providers and purchaser. Cost incurred in processing claims electronically and manually were estimated by assessing the resource use and their corresponding costs. Sensitivity analysis was conducted to assess the robustness of the results to variations in discount rate and proportions of claims processed under E-claims compared with paper claims. The combined sample of providers and purchaser made incremental gains from processing claims electronically. The IBCR was -19.75, 25.56 and 5.10 for all (sample) providers, purchaser and both providers and purchaser, respectively. When projected for the 330 facilities submitting claims to the NHIS claims processing centre (CPC) as at December 2014, the IBCR were -35.20, 25.56 and 90.06 for all providers, purchaser and both providers and purchaser. The results were sensitive to the discount rate used and proportions of E-claims compared with paper claims.

Conclusion: Electronic processing of claims is more efficient compared with manual processing, hence provide an economic case for scaling it up to cover many more healthcare facilities and NHIS CPCs in the Ghana.

Keywords: health economics; health policy; quality in health care.

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Conflict of interest statement

Competing interests: JN received consultancy fees to undertake the study. ATS and WH are both employees of the funder.

Figures

Figure 1
Figure 1
Claims processing flow chart at the National health Insurance Authority. Source: Authors’ construct based on interviews with NHIA staff. NHIA, National Health Insurance Act
See this image and copyright information in PMC

References

    1. Agyepong IA, Adjei S. Public social policy development and implementation: a case study of the Ghana National health insurance scheme. Health Policy Plan 2008;23:150–60. 10.1093/heapol/czn002 - DOI - PubMed
    1. Ansah EK, Narh-Bana S, Asiamah S, et al. Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: a randomised controlled trial. PLoS Med 2009;6:e1000007. 10.1371/journal.pmed.1000007 - DOI - PMC - PubMed
    1. McIntyre D, Garshong B, Mtei G, et al. Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania. Bull World Health Organ 2008;86:871–6. 10.2471/BLT.08.053413 - DOI - PMC - PubMed
    1. Witter S, Garshong B. Something old or something new? social health insurance in Ghana. BMC Int Health Hum Rights 2009;9:20. 10.1186/1472-698X-9-20 - DOI - PMC - PubMed
    1. Agyepong IA, Aryeetey GC, Nonvignon J, et al. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach. Health Res Policy Syst 2014;12:35. 10.1186/1478-4505-12-35 - DOI - PMC - PubMed

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