Coverage, pricing, and reimbursement of telemedicine: a qualitative study among implementers of the Akoma Pa mHealth-based telemedicine intervention in Ghana

Abstract

Healthcare systems are rapidly using digital health technologies, such as mHealth-based telemedicine, as digitalization in healthcare provision advances. However, there is limited knowledge of the pricing and reimbursement mechanisms for these health interventions, especially in the Global South. This study aimed to investigate healthcare professionals’ perspectives on the coverage, pricing, and reimbursement of telemedicine services in Ghana. This study used a qualitative exploratory design. Multistage sampling was employed. All 46 sampled Christian Health Association of Ghana (CHAG) health facilities across Ghana, with a focus on the “Akoma Pa Champions”, were invited; 29 responded and participated, at which point data saturation was reached. Data collection was done in February 2024 through semi-structured interviews. Thematic analysis was done using ATLAS.ti. Participants shared that the Akoma Pa intervention targeted hypertensive and diabetic patients, offering free medications and services, but limited drug options raised concerns. Pricing was absent, with free services, although participants debated whether mHealth should be priced less or at the same rate as traditional care. Reimbursement lacked structure and offered only modest non-monetary incentives, while in some cases, others received nothing. Funded by a non-governmental organization (NGO), the project boosted patient attendance through cost savings but faced challenges, including internet issues, patient skepticism, and limited scope. Suggestions from participants included integrating the National Health Insurance Scheme (NHIS), expanding disease coverage, and increasing investment for sustainability. The Akoma Pa intervention improves access to care for hypertensive and diabetic patients in Ghana by reducing costs and increasing engagement. However, its sustainability is limited by a narrow scope, a lack of pricing frameworks, dependence on external funding, and connectivity issues. Expanding its scope, integrating with NHIS, establishing an adequate regulatory framework, and investing in infrastructure can enhance its impact and scalability.