TY - JOUR
T1 - Readiness of Ghanaian health facilities to deploy a health insurance claims management software (CLAIM-it)
AU - Abekah-Nkrumah, Gordon
AU - Antwi, Maxwell
AU - Attachey, Alex Yao
AU - Janssens, Wendy
AU - Rinke de Wit, Tobias F.
N1 - Funding Information: The article is based on a report funded by the Pharm Access Foundation, Ghana. Pharm Access provided support in the form of salaries for the corresponding author (GAN), who was mainly responsible for study design, data collection and analysis, report writing, decision to publish and preparation of the manuscript. Staff members of the funder who are co-authors of this manuscript provided inputs and review comments which are clearly articulated in the ‘author contributions’ section. The authors acknowledge the contributions of health personnel in all the facilities where data for the paper was collected. We equally express our gratitudes to Doris Oti-Boakye and Richmond Owusu who assisted in data collection. Publisher Copyright: © 2022 Abekah-Nkrumah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/10/5
Y1 - 2022/10/5
N2 - INTRODUCTION: Inadequate, inefficient and slow processing of claims are major contributors to the cost of health insurance schemes, and therefore undermining their sustainability. This study uses the Technology, Organisation and Environment (TOE) framework to examine the preparedness of health facilities of the Christian Health Association of Ghana (CHAG) to implement a digital mobile health insurance claims processing software (CLAIM-it), which aims to increase efficiency. METHODS: The study used a cross-sectional mixed method design to collect data (technology and human capital capacity and baseline operational performance of claims management) from a sample of 20 CHAG health facilities across Ghana. While quantitative data was analysed using simple descriptive statistics statistics (frequencies, mean, minimum and maximum values), qualitative interviews were recorded, transcribed and abstracted into two major themes that were reported to re-enforce the quantitative findings. RESULTS: The quantitative results revealed challenges including inadequate computers and accessories, adequate numbers and skills for claims processing, poor intranets and internet access, absence of a robust post-implementation support system and inadequate standard operating procedures (SOPs) for seamless automation of claims processing. In addition to the above, the qualitative results emphasised the need to make CLAIM-it more flexible and capable of being integrated into third-party softwares. Notwithstanding the challenges, decision-makers in CHAG health facilities see the CLAIM-it software as having better functionality and superior capabilities compared to existing claims processing systems in Ghana. CONCLUSION: Notwithstanding the challenges, the CLAIM-it software is more likely to be adopted by decision-makers, given the positive perception in terms of superior functionality. It is important that key actors in claims management at the National Health Insurance collaborate with relevant stakeholders to adopt the CLAIM-it software for claims processing and management in Ghana.
AB - INTRODUCTION: Inadequate, inefficient and slow processing of claims are major contributors to the cost of health insurance schemes, and therefore undermining their sustainability. This study uses the Technology, Organisation and Environment (TOE) framework to examine the preparedness of health facilities of the Christian Health Association of Ghana (CHAG) to implement a digital mobile health insurance claims processing software (CLAIM-it), which aims to increase efficiency. METHODS: The study used a cross-sectional mixed method design to collect data (technology and human capital capacity and baseline operational performance of claims management) from a sample of 20 CHAG health facilities across Ghana. While quantitative data was analysed using simple descriptive statistics statistics (frequencies, mean, minimum and maximum values), qualitative interviews were recorded, transcribed and abstracted into two major themes that were reported to re-enforce the quantitative findings. RESULTS: The quantitative results revealed challenges including inadequate computers and accessories, adequate numbers and skills for claims processing, poor intranets and internet access, absence of a robust post-implementation support system and inadequate standard operating procedures (SOPs) for seamless automation of claims processing. In addition to the above, the qualitative results emphasised the need to make CLAIM-it more flexible and capable of being integrated into third-party softwares. Notwithstanding the challenges, decision-makers in CHAG health facilities see the CLAIM-it software as having better functionality and superior capabilities compared to existing claims processing systems in Ghana. CONCLUSION: Notwithstanding the challenges, the CLAIM-it software is more likely to be adopted by decision-makers, given the positive perception in terms of superior functionality. It is important that key actors in claims management at the National Health Insurance collaborate with relevant stakeholders to adopt the CLAIM-it software for claims processing and management in Ghana.
UR - http://www.scopus.com/inward/record.url?scp=85139306409&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85139306409&partnerID=8YFLogxK
U2 - https://doi.org/10.1371/journal.pone.0275493
DO - https://doi.org/10.1371/journal.pone.0275493
M3 - Article
C2 - 36197932
SN - 1932-6203
VL - 17
JO - PLOS ONE
JF - PLOS ONE
IS - 10
M1 - e0275493
ER -
