Presentation (CTI)

Problem Statement: Ghana’s National Health Insurance Scheme (NHIS) seeks equitable healthcare, but fixed tariff caps on epilepsy medications cause supply shortages, increasing seizures, healthcare costs, and rural inequities. This challenges policymakers to design sustainable reimbursement policies for chronic illness care.
Description: NHIS reimburses epilepsy medications below market prices, leading pharmacies to limit stock due to losses. NHIS data (2016-2020) show medication shortages affected 60% of rural versus 30% of urban epilepsy patients, driven by reimbursement delays (up to 10 months rurally). This correlates with a 25% rise in seizure-related readmissions. Disability-adjusted life years (DALYs) averted analysis indicates consistent access prevents 15% more DALYs for epilepsy than other neurological conditions. The six-visit annual limit for chronic care restricts monitoring, worsening adherence. Cost-effectiveness models, using real-world evidence, project a 20% readmission cost reduction with policy reform, highlighting inequities.
Lessons Learned: NHIS tariff caps undermine epilepsy care equity, disproportionately impacting rural patients. Health Economics and Outcomes Research (HEOR) evidence reveals fixed reimbursement rates increase long-term costs and disparities. Stakeholder dialogues, informed by this case, advocate for dynamic pricing and Health Technology Assessment (HTA) to align reimbursements with market and clinical needs, projecting a 30% adherence improvement. These reforms offer scalable solutions for low- and middle-income countries (LMICs), underscoring HEOR’s role in balancing cost-effectiveness and equity in policy design.
Stakeholder Perspective: This case reflects the government perspective, as NHIS is government-funded. Policymakers grapple with fiscal sustainability versus equitable access. HEOR evidence empowers budget reallocation and reform decisions, enhancing chronic illness care delivery in Ghana and informing global LMIC reimbursement strategies.