Leveraging on NHIS technical know-how, key in achieving universal health coverage

As government budgetary allocations at both federal and state levels to fund healthcare appears inadequate, health insurance has remained an alternative source of funding healthcare in the country with potential to secure universal access.

While the Federal Government set up the National Health Insurance Scheme (NHIS) with the aim of ensuring that every Nigerian has access to good health care services, limit the rise in the cost of healthcare services, ensure equitable distribution of healthcare costs among different income groups and ensure high standard of healthcare delivery to Nigerians, the scheme has not taken its roots across the nation.

Following the push by Femi Thomas, executive secretary, NHIS, to ensure that more Nigerians are covered by the rejuvenated scheme in line with achieving 30 percent universal health coverage by 2015, state governments have been urged to key into technical support of NHIS to achieve insurance coverage within the state level.

Lekan Ewenla, managing director, Ultimate HMO, said that as some states are setting up their health insurance scheme to cover its citizens, it needs to tap into the technical support of the NHIS which has offices in the 36 states for technical support and training, if the need arises.

While noting that out-of-pocket payment for medicare constitutes a huge chunk of private spending as few Nigerians are covered by health insurance at both public and private sector, Ewenla noted that Nigerians should change their health-seeking behaviour and embrace health insurance as it is a panacea to accessing healthcare anytime without experiencing any difficulty.

“Low awareness levels and attitude of most Nigerians towards embracing health insurance has led to poor penetration of insurance. While health insurance is still a new business and people do not understand the business of insurance, this has led to low acceptance of health insurance, which is considered the future of healthcare in Nigeria.

“Healthcare providers must work with players in the health insurance sector to provide a solid platform and facilitate growth of health insurance. A patient on the scheme should receive the same quality of care that patients paying out of pocket are enjoying. This is a way healthcare providers can help promote the scheme. We must raise the bar of qualitative service delivery,” Ewenla concluded.

Despite its dream of ensuring Nigerians have access to adequate and affordable healthcare through embracing health insurance, some state governments are yet to adopt health insurance for its citizens, a situation experts believe may jeopardise Nigeria’s quest to meet the 30 percent Universal Health Coverage target for Nigerians by 2015, BusinessDay investigation has revealed.

High out-of-pocket payment for healthcare expenditure dominated non-food items and services bought in 2013, according to Nigerian Bureau of Statistics (NBS), with majority of Nigeria’s 160 million people without health insurance cover.

Alexander Chiejina

This recent survey is in tandem with data from the World Bank’s which suggests that more than 150 million people globally suffer financial catastrophe annually due to out-of-pocket health expenditures and Nigeria has about the highest out-of-pocket health spending in the world.

According to the World Health Organisation (WHO), “a health system where individuals have to pay out of their own pockets at the moment of seeking treatment restricts access to only those who can afford it, and is likely to exclude the poorest members of the society.”

While Nigeria works towards meeting the presidential mandate of putting at least 30 percent of Nigerians on NHIS, there is need to learn from working models in countries such as India, Colombia and Thailand who have achieved UHC.

Colombia approved its universal health insurance scheme in 1993, creating the National Social Security System for Health, which currently covers more than 95 percent of the population. There are two insurance regimes: the Contributory Regime (CR), which covers workers and families with monthly incomes above $170 (N27,200) monthly and the Subsidised Regime (SR), which targets poor or informal workers.

Since 2012, both groups have been able to access the same health benefits package. A mandatory payroll tax contribution of 11 percent funds the CR. National and local tax revenues and a 1.5 percent payroll tax fund the SR. Colombia’s expanded SR scheme is possible through financial contributions from the federal government, local authorities at the district and municipal level, and solidarity contributions from members of the CR.