Implementation Status & Results Ghana Health Insurance Project (P101852)

Transcription

1 Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results Ghana Health Insurance Project (P101852) Operation Name: Health Insurance Project (P101852) Project Stage: Implementation Seq.No: 16 Status: ARCHIVED Archive : 25-May-2014 Country: Ghana Approval FY: 2008 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): National Health Insurance Authority Key s Board Approval 03-Jul-2007 Original Closing Planned Mid Term Review Last Archived ISR 30-Dec-2013 Effectiveness 10-Dec-2007 Revised Closing Actual Mid Term Review Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to strengthen the financial and operational management of the National Health Insurance Scheme by improving: (i) the policy adaptation and implementation capacity of the National Health Insurance Council in addressing ongoing core policy issues related to contribution collection, risk equalization, and provider payment mechanisms; and (ii) the purchasing function of the District Mutual Health Insurance Schemes, and the billing function of the Providers. Has the Project Development Objective been changed since Board Approval of the Project? Yes No losure Authorized Public Disclosure Authorized Component(s) Component Name Component Cost Streamlined Purchasing Policies and Mechanisms 2.05 Strengthening Integrated Claims Management Systems 8.60 Project Management 0.00 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview Project achieved the targets set for three PDO indicators: (i) proportion of total claims submitted by providers to NHIS (District Mutual Health Insurance Scheme or Claims Processing Center) for processing that passed the initial screening; (ii) proportion of total clean claims that are reimbursed by payers (NHIS) to providers within 60 days of claims receipt; and (iii) % of population within the lowest quintile registered under NHIA and with a valid card. Page 1 of 6

2 The indicator of "number of total claims received electronically by processors from providers" is progressing impressively. As of February 2014, a total of 709,190 claims were submitted electronically from one National Referral Hospital, 8 Regional Hospitals and 21 District Hospitals submitting eclaims. Compared with three month ago when 430,960 claims were processed electronically, this indicator has progressed at a rate of 22 percent per month on average. With this momentum continuing, it will reach 2.5 million during the next 12 months. All activities under Component A - Streamlined Purchasing Policies and Mechanism - have been completed. These include the capitation pilot that was successfully completed and and reviewed; accreditation of providers, gate keeper and referral policy training with about 4,154 health providers and health insurance scheme staff trained. Under Component B - Strengthening Integrated Claims Management Systems, - the Health Data Dictionary (HDD) is completed and is being matched against the Ghana Health Service elements to ensure that their health facilities can generate report and submit through the District Health Information Management System II (DHIMSII). The project fund is 100 percent percent disbursed. As contained in the medium term strategic plan 2010 of the National Health Insurance Authority (NHIA), one of the goals of the NHIA is to increase coverage of the poor and vulnerable under the National Health Insurance Scheme (NHIS). As part of efforts to meeting this goal, the NHIA embarked on a special registration of the poor and vulnerable unto the NHIS between June and August At the end of the exercise about 1.2m poor and vulnerable persons got enrolled unto the scheme. The preliminary judgment is that relevance of the project is high, particularly after project restructuring, and taking into account that 3 out of 4 PIs have been achieved with great extended impact. Project implementation was handled well by a strong team at the NHIA, which is comprised of highly competent professionals. Overall, this type of institutional building projects are critical to put in place the necessary building blocks to facilitate access to quality medical care services and and protect the population from financial hardship in case of illness and disability that is commonly associated with out of pocket payments. By supporting the development of a modern risk pooling arrangement for health care in Ghana in the form of the NHIS, the project contributed to advance universal health coverage in the country--after 10 years, the scheme covers about 10 million registered affiliates or close to 50 percent of the total population in the country. To prepare for the closing of the project: 1) The field work for beneficiary assessment has been competed by the recruited firm. A draft report is expected by mid April ) The ICR mission was carried out in the week of March 17, 2014; the team has had meetings with the project team, National Health Insurance Authority authorities and teams, Ghana Health Services, Christian Health Association in Ghana, one teaching hospital, and beneficiary hospital. The ICR team also visited a teaching hospital and the national claims processing center. 3) The ICR team also proposed an economic assessment of the eclaims system and had initial discussions with the counterpart. This will be a cost-benefit analysis evaluating the soundness of the project's investment on eclaims system supported by this project, aiming to quantify the intended and unintended benefits such as efficient claims processing, increased capacity to identify fraud claims and inappropriate services. Locations Country First Administrative Division Location Planned Actual Ghana Ashanti Region Ashanti Region Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target # of total claims received electronically by Number Value processors (NHIS) from provider M&E system Source: Eclaims Data Base Page 2 of 6

3 % of total claims submitted by providers to NHIS (DMHIS or CPC) for processing that passed the initial screening (i.e. not rejectedby first electronic/manual review) % of total "clean" claims that are reimbursed by payers (NHIS) to providers within 60 days of claims receipt % of population in the lowest quintile (20% of the index of socio-economic status) registered under the NHIS with a valid card Percentage Value M&E system Considered during Project restructuring. Source: Baseline: M&E system; CCP and DMHIS M&E system Percentage Value M&E system Considered during Project restructuring. Source: Baseline: M&E system; Annually: Random representative provider-level sample survey; Bi-Annual: NHIA M&E System Percentage Value Dec-2008 Source: 2008 Ghana DHS NHIA Progress data. This Considered during Project target has been met. restructuring. Source: Ghana Living Standard Survey Report (GLSS5) 2005/6 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target HR Strategy approved by Management (MoH/ Text Value None Policy Document has been Developed IASC/ Board) approved by NHIA Board and it is been implemented. Submission of HR document from NHIA to the Bank through HIP HMIS Master Plan for (including implementation plan and cost estimates for hardware, software, training and maintenance) approved by Management (MoH/IASC) NHIS population exemption policy (with implementation plan and cost projections) for the enrollment of the poor approved by Management (MoH/IASC/ Board) Text Sub Type Supplemental Value No ICT Master Plan developed and completed Text Value No As contained in the medium term strategic plan 2010 of the National Health Insurance Authority (NHIA), one of the goals of the NHIAis to Yes Yes Page 3 of 6

4 Provider payment policy, implementation strategy, guidelines and tools for NHIS approved by Management (MoH/IASC/ Board) Financial sustainability strategy for NHIS approved by Management (MoH/iasc/) increase coverage of the poor and vulnerable under the National Health Insurance Scheme (NHIS). As part of efforts to meeting this goal, the NHIA embarked on a special registration of the poor and vulnerable unto the NHIS between June and August At the end of the exercise about 1.2m poor and vulnerable persons got enrolled unto the scheme. Common Targeting Mechanism (CTM) developed and being used to increase enrollment of the poor. 28-Mar-2014 Submission of policy This target has been met. document from NHIA to the Bank through HIP Source: NHIA Progress This target has been met. Report. Health personnel receiving training (number) Number Value Source: NHIA Project Unit Target surpassed Health Data Dictionary approved 31-Dec-2011 Submission of document from NHIA through HIP HMIS Master Plan for (including implementation plan and cost estimates for hardware, software, training and maintenance) approved by Management (MoH/IASC) Submission of document from NHIA through HIP Page 4 of 6

5 CPC has "gone live" with its first electronic claim automatically vetted and paid First call received through the NHIA call Center and successfully responded % of total claims that are submitted by providers to NHIS (CPC or DMHIS) within 60 days of service provision Comprehensive and streamlined cost containment policy for NHIS approved by management (MOH, IASC, Board) 11-Nov-2013 Source: NHIA Progress Report Source NHIA Strategy Department NHIA funded this activity from own source and the Center continues to function satisfactorily Percentage Value HIP Implementation Unit Source: HIP Implementation Unit. Text Value Submission of document from NHIA through HIP Data on Financial Performance (as of 18-Mar-2014) Financial Agreement(s) Key s Project Ln/Cr/Tf Status Approval Signing Effectiveness Original Closing Revised Closing P IDA Closed 03-Jul Aug Dec-2007 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P IDA Closed XDR Disbursement Graph Page 5 of 6

6 Key Decisions Regarding Implementation A nine month extension of closing date was granted in June 2013 and the new closing date was March 31, Restructuring History Level two Approved on 25-Apr-2011, Level two Approved on 24-Jun-2011, Level two Approved on 03-Dec-2012 Related Projects There are no related projects. Page 6 of 6