Against the backdrop of N51bn allocation for health sector capital projects in the 2017 budget, enacting a regulation that will ensure universal coverage at a monthly premium of N1,500 and average of N18,000 yearly for an estimated 180million people will increase funding for the sector to the tune of N1.9trn.
Currently the National Health Insurance Scheme (NHIS) established in 2005, though it became law in 1999, and formed to increase healthcare access for Nigerians has achieved less than 10 per cent enrolment on both the public and private health insurance schemes managed by 60 accredited Health Management Organisations (HMO).
“At the moment both the NHIS and the HMOs have covered around 10 per cent of the population,” said Kolawole Owoka, immediate past chairman of Health and Managed Care Association of Nigeria (HMCAN), the umbrella association of private health insurers.
This has made healthcare a non-viable business and created an abnormal system where the public and the private sector compete for patronage with massive movement of patients to poorly funded public health facilities where there is a perception of cheaper cost.
The end result is an overburdened public healthcare system, with artificial scarcity in the private sector as low income patients avoid the private healthcare system due to exorbitant cost of services. Yet it is estimated that Nigeria loses over N500billion annually to medical tourism to foreign countries.
To deepen coverage, expert say the current dysfunctional healthcare financing system largely out-of-pocket spending by millions of Nigerians and inadequate federal budgetary allocation of 4.17 of the national budget against the recommended World Health Organisation (WHO) standard 15 per cent would have to be addressed.
“It has become imperative to strengthen the lawsetting up the health insurance scheme to make it mandatory as a predominant mode of health care financing in Nigeria,” said Danesi Mustapha, a physician at the College of Medicine, University of Lagos.
Mustapha said the provision of subsidized health care currently being practiced by Federal, State and Local Governments should be replaced by National Health insurance Scheme for everyone and NHIS should be strengthened as a regulatory body to facilitate the implementation of the Scheme.
“NHIS should leave implementation of the Scheme to accredited HMOs and not get involved in implementation apart from facilitating it. Attempt to get involved in implementation had resulted in failure in the past,” Mustapha said.
States in Nigeria have had difficulty implement a health scheme. There have been instances where state governments who paid money to the Agency for the Scheme in their States later had to withdraw it.
“A better model is for the States to have state insurance agencies of their own working synergistically with the National Insurance Agency to regulate and facilitate the Scheme in their states,” Mustapha said.
The act setting up the NHIS mandates that the Federal Government, the employers of labour contribute 3.5 per cent while the workers are to contribute 1.7 percent of the consolidated salary structure.
“But at it is now, it is only the Federal workers that are participating, even the 1.7 per cent they are supposed to contribute they have not really started contributing because labour has not really accepted that it should commence,” Attahiru Ibrahim, general manager, contributions management department of NHIS said in a speech at a retreat for National Orientation Agency, NOA, Directors on the NHIS for Quality Health care in Lagos last week.
He said at the moment only the 3.5 per cent contribution from the Federal Government’s was being used to keep the Scheme afloat.
