Health insurance has barely scratched the surface in Nigeria with regards to percentage coverage of the population.
97% of Nigeria’s population is not covered by any kind of health insurance. The three percent (3%) of the population who have health insurance are provided for by employee health coverage.
Unsurprisingly, of the three percent of Nigerians with health insurance, men have more insurance coverage than women as 56.7% of those covered are male as against 43.3% of the women.
Access to affordable healthcare remains out of reach for most Nigerians especially those without formal employment.
Despite introducing various health insurance programs, the National Health Insurance Scheme (NHIS) has failed to capture those out of the employment cycle. The cumulative coverage rate of these other programs was less than one percent of those covered by health insurance.
The alternative to health insurance is huge out-of-pocket spendings on health, and in 2018, Nigeria ranked the third highest country with the highest out-of-pocket health spendings. 76.6% of health spending in the country was out-of-pocket.
Per capita out-of-pocket expenditure is $64.16. Out-of-pocket spending per capita means the amount Nigerians pay from their pocket on the average in US Dollars. High out-of-pocket spending usually has catastrophic effects, impoverishing households.
State of Health Insurance
The National Health Insurance Scheme (NHIS), established by Act 35 of the 1999 constitution, was mandated to regulate health insurance services in Nigeria. It began operation in 2005, where it pools funds for the payment of health insurance.
This payment is made through Health Management Organisations (HMO) registered under the scheme. There are 58 HMOs registered with the NHIS, of which 49 (77.6%) of them have a nationwide presence.
To enhance grassroots penetration, NHIS decentralized the implementation of the health insurance scheme. Thus, state governments were expected to replicate the same in their states. However, as of 2019, only 18 states have or are considering signing the State-Based Health Insurance Scheme (SHIS) into law, with Lagos State being the first in 2015.
Despite these steps, insurance coverage has remained poor, with varying consequences. A survey report shows how continuous out-of-pocket payment caused significant catastrophic effects on households, further pushing more into poverty.
Primary Health Care (PHC) Exclusion
The NHIS stipulated the types of health care providers eligible for the scheme. These health care providers include primary, secondary, and tertiary hospitals across the country.
Despite the NHIS providing the details of the required standard expected for health care providers to be considered for the scheme, PHCs are usually not on the list of healthcare providers.
The neglect of the PHCs from providing these services by the HMOs seems to automatically exclude those living in remote areas from benefiting from the scheme. Most Health Management Organisations are located in urban areas and so focus their attention on urban dwellers. It is possible that the exclusion of PHCs is simply a commercial one based on the assumption that rural dwellers cannot afford the insurance premiums to access healthcare.
The coverage provided by the regulatory agency (NHIS) itself has not seen much uptake. Although it is the employer health coverage provided by most federal government institutions, there have been complaints by beneficiaries that the coverage is often useless against major illnesses.
The body itself has been rocked by several corruption scandals.
Optimizing Health Insurance in Nigeria
The benefit of health insurance cannot be over-emphasized; thus, there is a need to optimize health insurance for all Nigerians especially for those not in formal employment like artisans. Enacting the sub-national health insurance scheme will ensure extensive coverage of eligible people especially in rural communities.
A report pointed out the need for an effective funding mechanism, optimizing the operation process, and effective governance. It will be an essential mechanism for effectively channeling government healthcare spending to the individual with clearly measurable outcomes.
To boost health insurance coverage, there is a need for the government to create cost reduction policies. This policy should focus on improving the benefit of participation for both the providers and benefactors.