Queen Máxima pushes for NHIS coverage of digital healthcare like NkwaPlus to reduce patients’ medical costs

Queen Máxima of the Netherlands has called for greater efforts to reduce out-of-pocket healthcare expenses in Ghana, particularly for patients living with chronic diseases who continue to pay for some medical services despite having health insurance.

The Queen believes Ghana's National Health Insurance Scheme (NHIS) must evolve to accommodate digital healthcare services that allow patients to receive medical attention from home without making frequent visits to hospitals.

Speaking during a policy dialogue with healthcare providers and policymakers at Manna Mission Hospital in Accra, Queen Máxima expressed interest in how Ghana could improve its health insurance system to reduce the financial burden on patients.

The engagement followed her interaction with three patients receiving treatment under a Value-Based Care initiative jointly developed by PharmAccess Ghana, the National Health Insurance Authority (NHIA) and the Christian Health Association of Ghana (CHAG).

The initiative combines hospital consultations covered by the NHIS with digital monitoring through PharmAccess' NkwaPlus platform.

Queen Máxima, who is visiting Ghana as the United Nations Secretary-General's Special Advocate for Financial Health, said health insurance remains critical to protecting households against unexpected medical expenses.

"Having health insurance is a very important part because it's one of the very big items of unforeseen costs for people," she said.

She acknowledged Ghana's progress in expanding health insurance coverage but expressed concern that patients still incurred substantial expenses when accessing healthcare.

"In not many countries in Africa do you have quite good insurance coverage on the health side. And if you do, I know that still a lot of people pay out of pocket for a lot of things, so it is still a big-ticket item for patients," she observed.

The Queen said she was interested in understanding how Ghana could build on its health insurance system to make healthcare more affordable and efficient.

"I want to learn from the Ghanaian example how you've seen this evolving and, looking into all the out-of-pocket side, how we can actually make that less, because that's always hurting the financial health of people," she said.

Queen explores expansion of NHIS to digital healthcare

Country Director of PharmAccess Ghana, Dr. Maxwell Antwi, who facilitated the engagement, explained that the discussion with patients had highlighted the relationship between health insurance, household finances and digital healthcare.

"We've just had a very interesting discussion with the patients, really speaking about what insurance means to them at the individual and household level," he said.

He also highlighted the need to expand healthcare financing to accommodate digital services that enable patients to receive medical attention without frequently travelling to hospitals.

"There is also the need to move this on to include digital care, so that they don't always have to come to the hospital but can be taken care of from home," he explained.

The NkwaPlus platform allows patients living with hypertension and diabetes to monitor their conditions remotely and share their readings with healthcare professionals.

The technology forms part of the Value-Based Care initiative being piloted by PharmAccess, the NHIA and CHAG to improve the management of chronic diseases while reducing avoidable healthcare expenditure.

The initiative has recorded improvements in hypertension management, with the proportion of participating patients whose blood pressure was under control increasing from 50 per cent at baseline to 57.1 per cent after 12 months.

More than 90 per cent of participating patients also indicated that they would recommend the service.

However, while hospital consultations under the initiative are covered by the NHIS, remote monitoring through NkwaPlus is not yet included in the Scheme's reimbursement arrangements.

NHIA defends increased investment in healthcare

Responding during the dialogue, the Chief Executive Officer of the NHIA, Dr. Victor Asare Bampoe said Ghana had made significant progress in increasing domestic financing for healthcare following the removal of the cap on the National Health Insurance Levy.

He explained that the decision had made additional resources available to the Scheme, allowing it to expand coverage, improve reimbursements and increase tariffs paid to healthcare providers.

The NHIA CEO said the government was also pursuing a shift in how healthcare investments are viewed.

"The first is the mindset shift, so that they see health not as a cost centre but as an investment centre," he explained.

He maintained that the additional financial resources had strengthened the Scheme's ability to deliver healthcare services, but acknowledged that greater attention must now be given to the outcomes achieved with those investments.

"That's all on the input side. That's all on the volume side. Where our friends then come in is, what are we actually paying for with that money?" he questioned.

He said this was why the Value-Based Care initiative had become relevant to the Authority's long-term healthcare financing strategy.

"That's why value-based care is something that is interesting for us, because there will come a time when we will not be able to get all those funds," he said.

"But then if we have results, that will speak for itself. So that's where Ghana is now. We are at those crossroads."

PharmAccess and partners seek reforms in healthcare payments

The policy dialogue brought together the NHIA leadership, PharmAccess Ghana Country Director Dr. Maxwell Antwi, PharmAccess Chief Executive Officer Dr Nicole Spieker, CHAG Executive Director Dr. Peter Yeboah and Manna Mission Hospital head Linda Ablorh.

A major issue under consideration was how Ghana could move towards paying healthcare providers based on improvements in patient outcomes rather than solely on the number of services delivered.

Under the Value-Based Care pilot, the NHIA and its partners have introduced non-financial incentives, including early reimbursement of claims and early re-credentialing, to encourage healthcare providers to prioritise patient outcomes.

The discussions also identified two proposed next steps: developing reimbursement tariffs for improved patient outcomes in managing chronic diseases and introducing NHIS payment arrangements for digital healthcare services such as NkwaPlus.

The proposals are intended to make digital healthcare more accessible while encouraging providers to deliver measurable improvements in patient health.

Speaking separately to JoyNews, CHAG Executive Director Dr. Peter Yeboah said the approach could help Ghana make better use of its healthcare investments.

"The key paradigm shift today is a shift from the volume of healthcare services to the value that we derive from that," he said.

"We should not be too fixated about the number or the volume of services that people utilise, but we should ask ourselves who is benefiting and what real benefit is coming out of that."

He maintained that improved patient outcomes and financial protection must remain central to healthcare reforms.

"The case is simple. Health is not a cost; it is an investment," he stressed.

Queen Máxima's engagement with the healthcare policymakers formed part of her four-day visit to Ghana, which focused on improving financial security and protecting households against unexpected expenses, including the cost of medical care.