Despite the low coverage offered under the National Health Insurance Authority, about 73 percent of Nigerians seem satisfied with out-of-pocket health expenditure, a new report by the Nigerian Medical Association (NMA) in collaboration with the Center for International Private Enterprise (CIPE) has shown.
The report titled ‘Assessment of Patients Satisfaction and Challenges with services Provided under the Nigerian National Health Insurance Authority: A National Survey’ set out to assess the challenges confronting the scheme and its operations and the extent to which these challenges have impacted service delivery to enrollees.
The NHIS which was recently repealed and renamed as the National Health Insurance Authority Act 2022 is the official social health insurance agency of the federal government of Nigeria that is saddled with the responsibility of providing quality healthcare services to Nigerians at very subsidized and affordable costs. It aims to reduce out-of-pocket health burden that may lead to catastrophic health expenditure.
According to the World Bank, there were 89 million poor persons in Nigeria as of 2020 but this number has been projected by the organization to hit 95.1 million in 2022. The over-reliance on out-of-pocket payment could exacerbate the level of poverty in the country.
However, about 97 percent of the population currently live without health insurance, according to a report by the Nigeria Demographic and Health Survey (2018 NDHS).
The research by NMA & CIPE employed a mixed study method conducted in four cities (Aba, Kano, Lagos, and Onitsha) that were randomly selected from the list of major cities in the 36 states of the federation. A sample size of over 1,000 enrollees from private and public healthcare facilities was used over a period of February to April 2022.
According to the research, about 89 percent of those surveyed are satisfied with NHIA services. However, despite the high level of patient satisfaction, some inefficiencies were found in the scheme.
The research also discovered there are unnecessary bureaucratic bottleneck that impedes enrollees’ easy migration from one health facility to another.
Furthermore, the Health Maintenance Organizations (HMOs) (“contractors”) don’t pay the health facilities as directed by the NHIA or provided in the NHIA guidelines.
“The problem is the HMOs (contractors) they have dealt with the facilities beyond repairs, to be frank, they have really frustrated us and if we go by that frustration, the scheme will die, so the beginning and end of it all are the HMOs. The HMOs are not paying the facilities, it is frustrating,’’ a respondent attests during the survey.
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There is also a problem of authorisation from the HMOs and payments. Some HMOs don’t pay despite the submission of debts being owed as directed by NHIA.
It was also discovered that some HMOs interfere with the jobs of healthcare providers by imposing their decisions on certain services rendered by the providers.
The research stated that the capitation of N750 per client per month paid to a health facility is below standard, and grossly inadequate with the current cost of medications.
There is also the lack of transparency by some health facilities, especially regarding claim for reimbursement. Some of these Health Care Providers (HCPs) claim for funds even when enrollees do not show up or use the services. The HCPs also, substitute services such as normal delivery for a Caesarian section.
Based on these, the researchers that the NHIA should pay the health facilities their capitations promptly their dues. Also, there should be an improvement in enrolment processes (activation of NHIA account) for immediate access to health care services.
“There is need for computerization of NHIS services with online platforms and databases that allow all stakeholders to participate seamlessly for easy communication. For example, clients should be able to register online and get all the information and services required from the HMO, without necessarily visiting their offices physically,” the study stated.
The research also recommends that the monthly capitation should be reviewed in view of current economic challenges with possibility of exploring other sources of funds for coverage of services.
In addition, the NHIS leadership and health authorities need to set up a strong grievance reporting mechanism if not already in place to obtain real-time information on infractions or challenges impeding service delivery at any level for immediate action.
