Purpose - The aim of this paper is to assess whether the Ghana Diagnostic Related Grouping mechanism has reduced the cost of health care within the National Health Insurance Scheme of Ghana. The paper also assesses the challenges plaguing the use of the G-DRG as a payment mechanism in the health insurance system of Ghana.
Design/methodology/approach - The study adopts a mixed approach. Data collection involved in-depth interviews with officials of the National Health Insurance Authority (NHIA) and service providers. Quantitative secondary data were sourced from the National Health Insurance Authority.
Findings - The study’s findings show that the introduction of the Ghana Diagnostics Related Groupings mechanism has rather escalated the cost of health care even though increased enrolment on the scheme is partly a contributory factor. The study reveals that the main challenges which have contributed to the escalated cost with the introduction of the Diagnostics Related Grouping mechanism includes poor understanding of the mechanism by key stakeholders, poor record keeping and most importantly, up-coding among other challenges.
Conclusion - The challenges associated with the implementation of the Ghana Diagnostics Related groupings means that the possibility of introducing a new or a blend of payment systems must be studied.
Ghana; Diagnostics Related Groupings; Health Insurance; Challenges; Cost Containment