Experts want funding sources defined in new insurance act

Experts are seeking more clarity on the sources of funding for the expansion of insurance coverage for all Nigerians in the New Health Insurance Act 2022, saying the current plan seems vague on how the financing will be generated.

They said despite the listing of additional sources of funding in the new act, it is still not explicit about specific targets that can consistently generate the size of funds needed to spread coverage, particularly for 83 million Nigerians estimated to be in the vulnerable group.

Some suggest that a general tax targeted at something common to all Nigerians should be introduced to create a pool of funding that can augment the resources available to the National Health Insurance Authority (NHIA). They want the government to be clear on what would be levied to achieve this new goal.

“As an industry player and also as a member of the Health and Management Care Association of Nigeria, we are advocating that the government should set up a form of tax to ensure everybody contributes something, Olumuyiwa Olusanya, chief executive officer, Health Partners HMO told BusinessDay in an interview.

“There should be a tax on something that every Nigerian pays for. That’s what they did in Ghana. They tried to tax almost everything every Ghanaian pays for and get more funding for their health insurance. We can now have a percentage of the tax channelled to NHIS,” he said.

Part of the shortcomings of the previous insurance scheme was that coverage was limited to less than five percent of the population, who are mostly members of the federal civil service. It left more than 70 percent of the population working in the informal sector uninsured and others in the private formal sector to fend for themselves through private health maintenance organisations.

According to the new act, the sources of funding for the vulnerable group include the Basic Health Care Provision Fund (BHCPF), health insurance levy, special intervention fund and grants, donations, gifts, and any other voluntary contribution.

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But apart from the BHCPF which has the certainty of being pooled through an annual grant from the federal government of not less than one percent of the Consolidated Revenue Fund, other financing sources listed do not seem guaranteed.

For 2022, the Federal Ministry of Health has disbursed N29.5 billion from the BHCPF to support the Primary Health System and aid the provision of Emergency Medical Treatment.

More than 107 billion was allocated across states through the NHIS, giving insurance coverage to a just a tiny fraction, 1,236,645 people, in a country of 206 million. This means just 0.6 percent of the entire population are provided insurance coverage in 2022.

Ibrahim Abubakar, dean of the Faculty of Population Health Sciences, University College London in a Lancet report assessing the new act said the Nigerian government needs to do more in deploying funds to deliver the right to quality health care for Nigerians, which would make people believe in it and contribute to it, and enforcing larger employers to pay the health insurance premiums.

“If they can do those three and create a narrative, even if it’s in starting with a few states where their governors are committed and serious to health care, then I think we could get in the right direction and along the lines that our Commission recommended,” he said.

Apart from addressing the funding model, experts have also called for uniformity in the adoption of the social health insurance scheme, saying it is essential to achieve a universal healthcare model.

There is no uniformity in the current structure in which states charge varying premiums and different benefits. it will lead to a lot of chaos.

Right now, there is an NHIS scheme and most of the people under that scheme are civil servants. States have also set up their own health insurance scheme and they have different packages. The Ilera Eko package is N8,000 per life, and N40,000 for a family for instance, which is different from NHIS N15,000 package per life.

“For us to achieve universal healthcare, there must be uniformity. Everybody should have just one social health insurance scheme. It will reduce a lot of confusion and make it easy to administer across the country,” Olusanya said.