Department of Health Policy, Planning and Management, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2022 May 9;12(5):e054757. doi: 10.1136/bmjopen-2021-054757.
The aim of this study was to evaluate the benefit-cost of E-claims. A benefit-cost analysis was used to evaluate the efficiency of E-claims from the perspective of the providers and the purchaser.
A benefit-cost analysis approach was taken for this economic evaluation. Furthermore, we estimated the incremental benefit-cost ratio (IBCR) of the intervention under assessment.
Purchasers and healthcare providers of the National Health Insurance Scheme (NHIS) of Ghana were the study population.
The analysis was stratified according to providers and purchaser. Cost incurred in processing claims electronically and manually were estimated by assessing the resource use and their corresponding costs. Sensitivity analysis was conducted to assess the robustness of the results to variations in discount rate and proportions of claims processed under E-claims compared with paper claims. The combined sample of providers and purchaser made incremental gains from processing claims electronically. The IBCR was -19.75, 25.56 and 5.10 for all (sample) providers, purchaser and both providers and purchaser, respectively. When projected for the 330 facilities submitting claims to the NHIS claims processing centre (CPC) as at December 2014, the IBCR were -35.20, 25.56 and 90.06 for all providers, purchaser and both providers and purchaser. The results were sensitive to the discount rate used and proportions of E-claims compared with paper claims.
Electronic processing of claims is more efficient compared with manual processing, hence provide an economic case for scaling it up to cover many more healthcare facilities and NHIS CPCs in the Ghana.
本研究旨在评估电子理赔的效益成本。采用效益成本分析方法，从提供者和购买者的角度评估电子理赔的效率。
本经济评估采用效益成本分析方法，并估算评估干预措施的增量效益成本比（IBCR）。
加纳国家健康保险计划（NHIS）的购买者和医疗保健提供者为研究人群。
根据提供者和购买者进行了分析。通过评估资源使用情况及其相应成本，估算了电子和手动理赔处理过程中的成本。进行敏感性分析，以评估结果对贴现率和电子理赔与纸质理赔处理比例变化的稳健性。提供者和购买者的综合样本通过电子处理理赔获得了增量收益。对于所有（样本）提供者、购买者以及提供者和购买者，IBCR 分别为-19.75、25.56 和 5.10。当根据截至 2014 年 12 月向 NHIS 理赔处理中心（CPC）提交理赔的 330 家医疗机构进行预测时，IBCR 分别为所有提供者、购买者和提供者和购买者的-35.20、25.56 和 90.06。结果对使用的贴现率和电子理赔与纸质理赔的比例敏感。
与手动处理相比，电子理赔处理更有效率，因此有经济理由将其扩展到更多的医疗保健机构和加纳的 NHIS CPC。
