Follow Us on Google
From Fred Ezeh, Abuja
The new National Health Insurance Authority (NHIA) has redefined health insurance in Nigeria. It came aboard on May 19, 2022, after 23 years. It raised the hope for improved access to quality and affordable health care services, and an end to out-of-pocket payment for health care services, which, according to experts, has been retrogressive and catastrophic.
Reports indicated that Nigeria, at 70 per cent, has the highest out-of-pocket expenditure for health care services, and the aim of the health insurance is to abolish that and bring more people into improved health care services.
Health insurance now compulsory
Director-general, NHIA, Prof. Mohammed Nasir Sambo, said the NHIA Act made health insurance compulsory for all Nigerians and for the benefit of all: “People will be compelled to enrol, otherwise they won’t enjoy the services of government or certain private-sector services.
“We are looking forward to a time, not too far from now, where children will be required to present evidence of health insurance before they are enrolled in schools, private or public.”
Section 14(1), chapter 2 of the new NHIA mandated that every resident of Nigeria must obtain a health insurance and this includes employers and employees in public or private sector with five staff and above. Others are informal sector employees and other residents of Nigeria.
It noted that nothing shall preclude a resident in Nigeria from obtaining private health insurance provided such a person participate in any state mandated health scheme.
Sambo said: “It will not be easy at the early stage, but people will be persuaded to see to need to enrol. They will be made to understand that it’s there to protect them.
“At a point, government might be forced to introduce policies that would make it mandatory to present evidence of health insurance before enrolment in school, hospital or any other service organizations.
“Ill-health is contributing significantly to poverty and I stand to be proven wrong. So, we need policies that will protect the people from going into poverty because of ill health.”
Vulnerable group fund
The vulnerable group is a critical part of the new NHIA Act. Section 25, Chapter 3, of the NHIA was explicit on the vulnerable group and the benefit package that such people would get. Vulnerable group is to subsidise the cost of health care service delivery to these vulnerable and indigent persons.
Funds for the group are expected to come from the Basic Health Care Provision Fund (BHCPF), grants, health insurance levy, special intervention funds from the government, investments from the council and other means as could be determined by the council.
Mechanism for the implementation of the vulnerable group fund is same as the BHCPF in the primary health care services. In BHCPF, funds are released straight to health facilities as against previous practice of routing the funds through other channels that could be misused or mismanaged.
NHIA said state structures would be used to achieve that. It would be closely monitored with the help of information and communication technology (ICT) system developed by NHIA.
The Office of the Vice President and Minister of Humanitarian Affairs would provide the data of the poor and vulnerable in the society, perhaps, using the register for the National Social Intervention Programmes (NSIP): “We would use that register to determine the vulnerable group persons, but states would be asked to validate the data especially during the capturing of people into the national health insurance services.
“Factors like demography, housing system, environmental health, socio-cultural system would gives us the comprehensive picture of the community and its people. However, one of the difficult thing to ascertain is income, because people always find it difficult to divulge their income.”
Expansion of insurance coverage
While health insurance services cover basic minimum package, there are exceptions for people with major heath challenges. For instance, cancer treatment has been included in the new NHIA package but with some conditions.
NHIA DG confirmed that a partnership was recently secured with Roche, a Swiss company that operates worldwide under two divisions, pharmaceuticals and diagnostics, for provision of treatment for cancer patients that are captured in the health insurance services:
“The aim of the partnership was to reduce the cost of cancer treatment by 50 per cent. In the remaining 50 per cent, NHIA will pay 30 per cent while the patient will carter for the balance of 20 per cent.
“We have started piloting the programme in about four teaching hospitals in Nigeria. There are other exemptions but we must note that services in NHIA are purchased and become effective based on the money aggregated.
“The interest of NHIA is to cover basic minimum health package, essential package. For instance, if a symptom of sickness comes, the person could freely visit hospital for check-ups if he or she has health insurance cover.
“But if otherwise, the person might choose or feel reluctant to visit the health facilities until the situation deteriorates. Evidences have shown that effective health insurance services would reduce the prevalence of diseases in human population.”
Health management organisations (HMOs)
Henceforth, the NHIA and states would drive the basic health care package, while the HMOs would provide three roles. First, any health insurance beyond basic health care services would be shifted and delivered by HMOs.
Second, the NHIA has recognised private health insurance, meaning that any private health insurance can be driven by HMOs. Third, HMOs can also register to perform a role called Third Party Administrator (TPA) within the national insurance system.
Before the new NHIA Act, HMOs were in total control of service delivery, including financial claims. The new act has shifted the responsibilities to NHIA. The funds hitherto controlled by HMOs for the basic health care services are now moved down straight to health care facilities and not through the HMOs as was the case in the past.
But there is an exception. If a corporate organisation requests for a comprehensive package, NHIA will collect premium for comprehensive health package. The supplementary would be sent to the preferred HMO of the organisation. And because of the reduction of the responsibilities of HMOs, the risk equalisation and capitalisation has reduced.
GIFSHIP programme
Group, Individual and Family Social Health Insurance Programme (GIFSHIP) is a health insurance package that is taken up and paid for by groups, individuals and families not covered by other NHIS coverage platforms.
Small-scale enterprises with less than 10 staff, self-employed individuals, families and groups, retirees, diaspora groups, foreigners living in Nigeria and several other people in that group are eligible for the package.
The programme is financed from contributions made by interested individuals. Individual contribution rate is N45,000 per annum. Such individual can add two direct dependants. In the GIFSHIP package, a family will contribute N60,000 for four biologically related persons, while extra dependant of the family will be enrolled at N15,000.
Similarly, 10 persons shall be the minimum number of persons in a group except small-scale enterprises with less than 10 employees. Group enrolment is at a contribution rate of N15,000 per person per annum. NHIA maintained that aforementioned rates are subject to changes as may be determined from time to time by NHIA.
Funding windows
Sambo explained that in the cause of preparing the NHIA Act, there was serious debate on the sources of funds for the health insurance services:
“It was suggested that there should be a tax that could come from telecommunications. We suggested a one kobo per second for every phone call to be set aside for health insurance. But that was rejected by the Federal Ministry of Finance.
“The observation was that it should be expunged from the NHIA. They suggested that such actions must come through the Finance Act to get legitimacy. We have not given up on that because it will still be revisited at the appropriate time.
“However, we realised that government has started tax on sugar and other sweet items. We are banking on that for money to fund health insurance.”
Implementation of NHIA Act
He said though the NHIA Act has been signed, they are still at the level of advocacy and consultations with all relevant stakeholders: “There are about 83 million people to be covered by the health insurance services and funds are required to do that.
“Besides, awareness is strongly required to get people’s support in order to achieve the desired success. There’s also the need for inter-agency collaboration to achieve that. Necessary laws are also required to ensure seamless implementation of the programme.
“There was no momentum to educate the people earlier when the NHIS Act was enacted years ago. That is what we are trying to correct this time. That’s one of the key strategies we are adopting to achieve our goal.”
