Delays in claims payment to credentialed healthcare providers; the financial implication on national health insurance scheme of Ghana

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The issue of Delays in Claims payment to credentialed healthcare providers by the National Health Insurance Authority since inception has always been a major concern. Healthcare providers have time on ends claimed that the delays affect their financial schedules and often have threatened opting out. The larger scope that however precipitated this study was how this delays in payments is financially implicating on all the 3 major stakeholders; the regulator, the policyholder and the credentialed healthcare provider. Descriptive Research design was employed and both primary data in the form of questionnaires and secondary data from the NHIA featured. It was found that policyholders suffer financially through out of pocket payment at point of service, credentialed healthcare providers receives payment ‘twice’ for services rendered by charging members at their facilities and then submitting claims on these same members to NHIA for payment This implied that the provider shortchange the Regulator financially. There is the need to critically assess the recommendations outlined in the study to ameliorate the financial implication the study has underscored.
A thesis submitted to the department of accounting and finance, school of business, Kwame Nkrumah university of science and technology in partial fulfilment of the requirements for the award of the degree of master of science in accounting and finance