The National Health Insurance Authority (NHIA) is calling for amendments to the National Health Insurance Act, 2012 (Act 852), to accommodate the government’s Free Primary Healthcare initiative and population-based payment systems.
Deputy Chief Executive Officer of the NHIA, Dr Kwesi Djokoto, told Parliament’s Health Committee that the existing legal framework needed to be updated to support the new healthcare financing arrangements and strengthen efforts to eliminate claims fraud, leakage and unauthorised charges imposed on patients.
“The legal framework is something that has to be modified to accommodate the free primary healthcare and the population-based payment methods,” he said.
Dr Djokoto said the Authority was pursuing tariff adjustments and deploying artificial intelligence (AI) and other digital tools to improve claims verification, identify fraudulent practices and address discrepancies between service tariffs and available funding for the National Health Insurance Scheme.
He also highlighted plans to establish an anti-fraud and illegal payments directory to help prevent and detect unauthorised charges, including illegal co-payments, and ensure appropriate sanctions for offenders.
He urged the committee to support the proposed legal changes, strengthen penalties for fraud and illegal co-payments, and help prioritise capital budget allocations for 2027.
Dr Djokoto said the NHIA had already introduced electronic claims processing to improve efficiency and accelerate reimbursements to healthcare providers.
“In summary, claims are fully electronic with 20 days turnaround time. We are paying monthly; we have digital interventions to enhance the work of the National Health Insurance Authority,” he said.
President John Dramani Mahama launched the Free Primary Healthcare initiative on April 15, 2026, to provide essential first-contact medical services without charge at the point of use.
Services are expected to be delivered through CHPS compounds, health centres, polyclinics, public health units, health posts, community pharmacies and mobile or container-based health kiosks in busy locations such as markets and lorry parks.