The Inclusion of emerging chronic illnesses is key to selling the LHIS health insurance scheme successfully to citizens may need to move beyond coverage of familiar infectious diseases to coming to terms with the reality presented by emerging chronic illnesses, which treatment requires continuous payment.
Laudable as the Lagos Health Insurance Scheme (LHIS) is, the impression among some stakeholders and healthcare providers who spoke with BusinessDay is that residents will be more attracted to the scheme if it extends coverage to non-communicable diseases that have become the nightmare of some Nigerians.
The LHIS caters for family planning and counselling, adolescent reproductive healthcare, health education, emergency health services, antenatal and postnatal care. It also covers normal delivery and caesarean section, prevention of mother to child transmission of HIV, immunisation, growth monitoring and promotion and management of childhood illnesses. These areas constitute 63 percent of mortality factors, which receives the most inflow of out-of-pocket health expenditure.
But emerging challenges including cancer, diabetes, hypertension, chronic kidney disease, chronic liver disease, cardiovascular and certain types of dental problems and surgeries are not covered. The World Health Organisation (WHO) in 2018 estimated that they account for 29 percent of all deaths. These diseases have been found to have an increasing impact on the health status in populations, with higher rates in developing countries, and constitute the leading cause of mortality worldwide.
“Part of the major challenge is that most of the services that are being provided are services that people can somehow pay for without having to buy insurance,” Oluwajimi Sodipo, the vice-president, Medical Guild, said. “If you are just going to treat yourself once, it is possible to still be able to pay for it. People that have chronic medical illnesses definitely find it difficult to pay for those services. They have to ensure that the coverage of services that they provide attract these people to the scheme.”
The LHIS is a mandatory programme that targets all registered residents of Lagos under a N3,850 monthly plan per family of six and N8,500 yearly for single persons. To guarantee operational funding for the Lagos State Health Management Agency (LASHMA) in including all stakeholders in the formal and informal sector, it became a law.
The law created equity fund that is a minimum of 1 percent of the consolidated revenue of the state to take care of the very poor people. According to sources in the state government, the agency used some fund in the first of 2019 to enrol people confirmed by an assessment to be poor slum dwellers.
As a way of increasing access, both private and public healthcare providers are eligible to provide services provided they are accredited under the scheme. About 9 health insurance agents (HIAs) have been accredited and assigned to specific local government to handle enlightenment and enrolment. They are to be paid by the agency based on the agreed contract.
Although funding was previously lacking, the current governor Babajide Sanwo-Olu was said to have backed the scheme with an undisclosed sum to fast-track the process enrolment process.
“My take is that there is serious hope, especially with funding of those things that were delayed towards the end of last year. I don’t have any doubt whatsoever that this current government will fast-track the process,” Jide Idris, former commissioner for health, told BusinessDay. “If the government or the agency can lobby the house by presenting evidence of requiring more funds, they should be to go higher than one percent.”
However, fears that the if fundamentals issues of underfunding of the health sector, low capitation and poor infrastructure persist, positive health outcomes might not grow at higher rates.
