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Background <p>Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 as a means of achieving Universal Health Coverage. The Ghana-Diagnosis Related Groupings (G-DRG) is one of the payment mechanisms used to reimburse providers for services and procedures. However, evidence suggests that the amount reimbursed for services through the G-DRG tariffs may be lower than the market prices for same, creating a financial gap that concerns providers.</p> Objective <p>The study assessed the financial implications of the G-DRG payment system on service delivery for inpatient services between 2018 and 2022 at the Greater Accra Regional Hospital in Ghana.</p> Methods <p>The study adopted a descriptive cross-sectional study design approach to gather and analyze the data. The 2021 annual performance report of the hospital was used to identify the top hundred reported inpatient admissions. Institutional data on G-DRG tariffs issued by the National Health Insurance Authority (NHIA) and the approved hospital charges for managing sampled medical conditions were extracted. The top ten conditions from the sample were used to determine the price differentials between G-DRG tariff and hospital charges for same conditions on admission.</p> Results <p>The study found that 3,323 (63.5%) of the top 10 conditions on admission in 2022 were related to children, with neonatal jaundice constituting the highest (1,177; 23%). Gastroenteritis, Septicaemia, hypertension and appendicitis were the common adult conditions on admission. While the G-DRG tariffs reported price increment every other year (16%), hospital price increment was unstable ranging from 20% to 58%. Nonetheless, the study found a cumulative financial gain to the facility of 23% on the top ten inpatient medical conditions over the five-year period.</p> Conclusion <p>While the G-DRG had positive price differentials over the five-year period, ensuring macroeconomic stability is important in maintaining the gains and supporting the financial viability of the G-DRG payment system. Future research should look investigate the relationship between price differentials and average length of stay in admissions.</p> Clinical trial number <p>Not applicable.</p>

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Ghana’s Diagnosis Related Grouping (G-DRG) tariffs versus hospital charges: implications for inpatient care financing at a secondary hospital in Ghana

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月22日

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  • Peter Gyasi Darkwa,
  • Genevieve Cecilia Aryeetey,
  • Eric Nsiah-Boateng

摘要

Background

Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 as a means of achieving Universal Health Coverage. The Ghana-Diagnosis Related Groupings (G-DRG) is one of the payment mechanisms used to reimburse providers for services and procedures. However, evidence suggests that the amount reimbursed for services through the G-DRG tariffs may be lower than the market prices for same, creating a financial gap that concerns providers.

Objective

The study assessed the financial implications of the G-DRG payment system on service delivery for inpatient services between 2018 and 2022 at the Greater Accra Regional Hospital in Ghana.

Methods

The study adopted a descriptive cross-sectional study design approach to gather and analyze the data. The 2021 annual performance report of the hospital was used to identify the top hundred reported inpatient admissions. Institutional data on G-DRG tariffs issued by the National Health Insurance Authority (NHIA) and the approved hospital charges for managing sampled medical conditions were extracted. The top ten conditions from the sample were used to determine the price differentials between G-DRG tariff and hospital charges for same conditions on admission.

Results

The study found that 3,323 (63.5%) of the top 10 conditions on admission in 2022 were related to children, with neonatal jaundice constituting the highest (1,177; 23%). Gastroenteritis, Septicaemia, hypertension and appendicitis were the common adult conditions on admission. While the G-DRG tariffs reported price increment every other year (16%), hospital price increment was unstable ranging from 20% to 58%. Nonetheless, the study found a cumulative financial gain to the facility of 23% on the top ten inpatient medical conditions over the five-year period.

Conclusion

While the G-DRG had positive price differentials over the five-year period, ensuring macroeconomic stability is important in maintaining the gains and supporting the financial viability of the G-DRG payment system. Future research should look investigate the relationship between price differentials and average length of stay in admissions.

Clinical trial number

Not applicable.