The National Health Insurance Authority (NHIA) has urged Parliament’s Select Committee on Health to support proposed amendments to the National Health Insurance Act, 2012 (Act 852), to provide the legal framework for implementing the government’s Free Primary Healthcare initiative and population-based payment reforms.
The Deputy Chief Executive Officer in charge of Operations at the NHIA, Dr Kwesi Djokoto, made the appeal on Monday, October 12, 2026, during a working visit by members of the committee to the Authority’s head office.
He explained that the existing legislation needed to be revised to accommodate emerging approaches to healthcare delivery and financing, while enhancing the NHIA’s capacity to address operational challenges facing the National Health Insurance Scheme (NHIS).
Dr Djokoto said the proposed amendments were essential to providing the legal foundation for the Free Primary Healthcare initiative and the adoption of population-based payment mechanisms.
“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 disclosed that the Ministry of Health was already working on the proposed amendments and called on the parliamentary committee to support efforts to expedite the process and make it a priority.
The NHIA also highlighted claims leakages, illegal co-payments imposed by some healthcare providers, and the disparity between approved service tariffs and available funding as key threats to the long-term sustainability of the insurance scheme.
According to Dr Djokoto, the Authority is implementing several interventions to tackle these challenges, including tariff adjustments, digital solutions and stricter enforcement measures to combat fraudulent claims and unauthorised charges.
He added that the NHIA was deploying artificial intelligence and other digital tools to strengthen claims verification, detect fraudulent activities and identify inconsistencies in claims submitted by healthcare providers.
The Authority is also establishing an anti-fraud and illegal payments directorate to strengthen its response to fraudulent claims and illegal charges imposed on insured patients. “We are responding appropriately with the tariff reset and the establishment of an anti-fraud and illegal payments directorate to be able to make sure that we prevent it, we detect it, and we also serve sanctions as a deterrent,” he said.
Dr Djokoto urged the committee to support stronger sanctions against individuals and healthcare providers involved in fraud and illegal co-payments, saying tougher enforcement would help protect the integrity of the scheme. He also called for support towards prioritising capital budget funding for 2027 to strengthen the Authority’s operations and digital infrastructure.
According to him, the National Health Insurance Authority (NHIA) has introduced electronic claims processing to improve efficiency and reduce delays in reimbursing healthcare providers. He mentioned that claims are now processed electronically, with a turnaround time of 20 days, and payments to providers are made monthly. “In summary, claims are fully electronic with a 20-day turnaround time. We are making monthly payments, and we have implemented digital interventions to enhance the operations of the NHIA,” he stated.
Additionally, the Free Primary Healthcare initiative, launched by President John Dramani Mahama on April 15, 2026, aims to provide essential primary healthcare services free of charge at the point of use. These services are expected to be delivered through community-based health planning and service compounds, health centers, polyclinics, public health units, health posts, community pharmacies, and mobile or container-based health kiosks located in busy areas such as markets and lorry parks.
The proposed amendment to Act 852 is intended to align the legal framework with this initiative and population-based payment methods while strengthening measures to combat fraud, illegal charges, and other challenges facing the NHIA.
