Clinical Experts brainstorm on finalization and consolidation of Ghana Diagnostic Related Groupings (G DRG) investigations | 4/8/2024

The specialist group of clinical experts reviewing Ghana’s Diagnostic Related Groupings (G- DRG) payment method of the National Health Insurance Scheme (NHIS) on April 5, 2024, converged at the AH Hotel, East Legon in Accra to update the outcomes of previous engagements.

The clinical experts, drawn from all specialty areas that are on the Benefit Package of the Scheme (NHIS) at the end of a three-day meeting brainstormed on finalization and consolidation of the Diagnostic Related Groupings investigations. 

The NHIS service tariff review consultant, Professor Adukwei Hesse circulated the review templates which served as a guide for the discussions.

The experts represented the Ghana Health Service (GHS), Korle Bu Teaching Hospital, Komfo Anokye Teaching Hospital,  Greater Accra Regional Hospital, Upper East Regional Hospital, Police Hospital, Ho Regional Hospital, Bank Hospital, Ghana Infectious Disease Centre, Society of Private Medical and Dental Practitioners, Accra Medical Centre, University of Cape Coast Hospital, Accra Psychiatric Hospital, Private Health Facilities Association of Ghana, Medicas Hospital, National Blood Service, Shai-Osudoku District Hospital, Fresh Luk Eye Centre, St. Joseph Hospital and the National Health Insurance Authority (NHIA).

As a statutory requirement, the series of meetings were in line with the NHIA Act 2012, (Act 852) section 34 subsection 1, which mandates the Authority to review the NHIS service list and service tariff in collaboration with healthcare providers.

The Convener, Acting Director, Strategic Health Purchasing Directorate (SPHD), Dr. Ruby Aileen Mensah Annan (Mrs.) said the meeting sought to build on the previous DRG reviews. 

A senior consultant with the World Bank, Professor, Dr. Sudha Chandrashekar in an interview lauded the collaborative approach to revising the G-DRG payment method of the NHIS.

“There have been incremental reviews overtime, but this current revision is the standardized process of sourcing ground up data to have comprehensive and rational G-DRGs to minimize or eliminate the rejection of Claims submitted for reimbursement.”

The former Executive Director of the National Health Authority, Government of India/Ministry of Health and Family Welfare emphasized, “These meetings are done in a much more methodological manner to make inclusions and eliminations and come out with a new GDRG.

This will ensure the actual reimbursement for healthcare services covered by the NHIS in line with the clinical guidelines.”

There have been series of ongoing meetings on the G- DRG payment method of the NHIS organized by the Strategic Health Purchasing Directorate (SHPD) of the NHIA), Head Office. The inception meeting was held on December 22, 2023, and there was a follow-up on March 13, 2024.