The Impact of eCLAIMS on National Health Insurance Claims Management in Ghana: A Case Study of National Catholic Health Service

Abstract

An efficient medical claims billing system is critical to mitigating the challenges associated with claim denials and ensuring the sustainability of providing healthcare services. The rapid growth in the Information and Communication Technology (ICT) sector has necessitated the implementation and use of Health Information Systems (HIS) in several healthcare facilities to improve healthcare delivery. This study assesses the impact of Health Information Systems (HIS) in reducing the rate of error margins of health insurance claims submitted by health facilities to the National Health Insurance Authority in Ghana. The study also seeks to assess the impact of HIS on the timeliness of medical claims submission in the National Catholic Health Service in Ghana. Assessing the HIS efficiency rate would build confidence among healthcare providers and other stakeholders to invest in health information technology for an efficient healthcare delivery system. The current study also assesses HIS efficiency rate based on users’ perspectives using two information system success model (ISSM) tools and measures the agreement between the two ISSM tools. The study used longitudinal data on monthly claims adjustments due to errors from paper-based and submitted claims using different HISs from 2010 to 2019. The rate of error margins was estimated for each month. Prais-Winsten Segmented Interrupted Time-Series analysis was used to estimate the impact of HIS by comparing claims data before and after the system implementation for each facility. I employed meta-analysis techniques to generate a pooled impact estimate of HIS on error margins of health insurance claims. The study also employed longitudinal data on the monthly timeliness of medical claims from both paper-based and electronic system using various forms of HIS from 2010 to 2019 was used. Number of days spent in submitting medical claims was deduced for each month. Segmented Interrupted Time-Series analysis-based Prais-Winsten method was used to assess the effect of HIS by comparing the average number of days spent in submitting claims data before and after the HIS implementation for each facility. Meta-analysis techniques were employed to estimate the pooled effect estimate of HIS on average number of days spent in submitting claims. On the HIS efficiency rate, the study was carried using survey method in 25 National Catholic Health Service (NCHS) hospitals in Ghana. The study adapted two self administered structured data collection tools based on extended ISSM covering six dimensions and upgraded DeLone and McLean models covering seven dimensions respectively. Descriptive statistics such as means and standard deviations were calculated for continuous variables and percentages for categorical variables. Cronbach’s alpha was used to assess the internal validity of study dimensions. The normality of data was assessed using the Shapiro-Wilk test. HIS efficiency rate was calculated for the two models using the weighted mean. The bland-Altman method was used to measure agreement between the two models. The total cost of deductions due to errors from the HIS was significantly lower than the paper-based system (HIS=8.15%, paper-based system=10.13%). HIS contributed to an immediate 1.31 percentage point reduction in the error margins of health insurance claims compared to the paper-based system. The timeliness of claims submission was above 75% in majority of health facilities. The average number of days spent submitting medical claims in HIS has significantly reduced compared to paper-based systems (HIS=35.11 days, paper-based=56.51 days; (p<0.0001)). The trend analysis showed that HIS contributed to an immediate 5.84 days reduction in the average number of days spent submitting medical claims compared to the manual system. The outcome of the HIS efficiency rate shows that a total of 1416 users from 25 hospitals across the country took part in the study. The two instruments were validated with a content validity index and content validity ratio above 0.90. The Cronbach’s alpha measurement was also above 0.75 for both tools. The overall mean HIS efficiency rate was above 80% showing the high efficiency of the HIS. The Bland-Altman method of measurement revealed that 24 (96%) out of 25 hospitals’ mean HIS efficiency rate lies between averages of 75.5% and 87.0%. The regression between the mean difference and the average of the two tools shows that there is no statistically significant proportional bias between the application of the two tools to measure HIS efficiency rate (coefficient=-0.50; 95%CI [-1.14 to 0.14] and p value=0.1228). The HIS recorded lower denied claims costs than the paper-based claims system. The implementation and use of HIS improved the timeliness of medical claim submission. Scaling up the use of HIS for claims submission will reduce the rate of claim denials, ensure the sustainability of providing healthcare services and will ensure prompt reimbursement by the insurer. The findings from this study emphasize healthcare providers’ perspective of HIS efficiency rate in a hospital setting in Ghana. The tools adapted in this research can be used to evaluate hospital information system in any future studies since there was no proportional bias between the two models.