The current state of Nigeria's National Health Insurance Scheme: Redefining strategies to achieve Universal Health Coverage
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Health insurance is a contract in which an organization is given a predetermined amount of money each month, and in exchange, the organization promises to pay doctors, hospitals, and pharmacies when the subscriber accesses health services – for preventive, chronic, emergency, diagnostic, etc. medical care – and purchases treatments. The idea is that the smaller, regular sums paid when in good health offsets the larger, full cost of care when a subscriber becomes ill or wounded. In Nigeria, there are two major forms of health insurance:
Public health insurance is administered by the Nigerian National Health Insurance Scheme (NHIS). The NHIS covers Nigerian nationals who meet the following conditions: government employees; those who work in the organized or informal private sector; children under the age of five; chronically disabled people; and jail inmates. Altogether, NHIS covers only about 5% of Nigerians.
NHIS aims to attract more resources to the healthcare sector, improve access to resources, and increase utilization of healthcare services. This is done in collaboration with private companies and private healthcare providers.
NHIS provides the following coverage:
Employers pay 10% and employees pay 5% for agencies in various tiers of government and the organized private sector, totaling 15% of each employee’s wage. In some situations, the employer may elect to cover the entire 15% of the employee’s salary; however, the employee may choose to make additional payments to strengthen their package as well. The enrollee’s contributions to the plan will cover the enrollee, one spouse, and four children under the age of 18. If the scheme is expanded to include more persons and children above the age of 18, the NHIS will assess further contributions.
The employee has to cover whatever is not covered under the NHIS Scheme and Health Management Organisation policies they are subscribed too. This means that if the HMO and NHIS policy and agreement is that malaria treatment is covered, then the subscriber will not pay for treatment for malaria. But, if there are some laboratory tests the subscriber needs, that are not covered in their scheme and policy, then they will have to pay for these tests completely out-of-pocket.
The problem with this arrangement is that most times, patients or their relatives don’t know ahead of time how much of their payment is covered under NHIS. They have to visit the NHIS office in hospitals to find out whether what they are about to pay for is covered by NHIS or not. Thus, despite this payment scheme, when it comes to paying for medical expenses, out-of-pocket payments are still very high. This has continued to drive many families into catastrophic health costs and poverty.
Contributors to the flaws of the NHIS include:
The uptake of health insurance can be facilitated using the following strategies:
1. Ifeanyi Nsofor: Without Health, we have nothing (TedxOguiRoad, 2018). Available at: https://www.youtube.com/watch?v=u4r_0TLTBQw
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