New Health Insurance Act: A new hope for the poor?
The National Health Insurance Authority Act was enacted in 2021. It repealed the National Health Insurance Scheme Act. The amended act was to ensure the effective implementation of the National Health Insurance Policy that would facilitate the attainment of universal health coverage in Nigeria. This is because a lot of experts had fingered the old […]
The National Health Insurance Authority Act was enacted in 2021. It repealed the National Health Insurance Scheme Act. The amended act was to ensure the effective implementation of the National Health Insurance Policy that would facilitate the attainment of universal health coverage in Nigeria. This is because a lot of experts had fingered the old law as the major impediment to the UHC.
With the new law, the National Health Insurance Authority (NHIA) has set a target that by the year 2030, Nigeria should have achieved Universal Health Coverage (UHC).
Public data show that over 190 mill per cent of total health spending in Nigeria is out-of-pocket. This runs into billions of naira.
With the renewed efforts at NHIA, efforts to tackle the high incidence of poverty caused by out-of-pocket expenses for healthcare through health insurance for all categories of Nigerians by 2030 are now more realisable than ever before, according to experts.
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The act establishes and empowers the NHIA to ensure the provision of health insurance for all Nigerians through a mandatory mechanism, in collaboration with state health insurance agencies.
Specifically, Sections 25 and 26 of the act established the Vulnerable Group Fund (VGF), indicating the various sources from which funding would be drawn.
Emmanuel Ononokpono, the spokesman of NHIA, said the legislation strengthens the NHIA to discharge a wide range of regulatory and promotion functions to ultimately ensure that every Nigerian receives access to quality and affordable healthcare.
The NHIA, through its various service platforms, is activating several initiatives that will make more Nigerians have access to health insurance.
Thus, the NHIA recently introduced an initiative, the Groups, Individuals and Family Social Health Insurance Programme (GIFSHIP) which is aimed at providing financial access to the quality health insurance scheme.
The policy as explained by officials of the NHIA at the Lagos Trade Fair recently, with N15,000, every Nigerian and foreigner residing in the country can access affordable health insurance services through accredited partners nationwide.
The health insurance agency noted that by the new NHIA Act 2022, the scheme has been made mandatory as against the defunct NHIS Act which made participation voluntary.
The scheme, the authority added, has been designed to accommodate social and trade groups, public service, organised private sector, corporates, families as well as individuals with access to accredited health management organisations (HMOs) and other healthcare providers across the country.
With each category of the health insurance plan which ranges from N15,000, N45,000, N60,000 to N150,000 only depending on the chosen plan, the authority stated, the enrollees are covered by the scheme for a whole year.
Under the GIFSHIP Plan, a family of three would have to pay the sum of N45,000, while a family of four would pay N60,000 and N15,000 each for an additional member.
Dr Kapoona Eteng, General Manager, Formal Sector Department of the agency, noted that NHIA is working to ensure that all Nigerians have access to quality and affordable healthcare in line with the universal health coverage (UHC) by 2030 and the global agenda of sustainable development goal (SDG).
She maintained that the health insurance target is to bring into health insurance net about 83 million vulnerable groups of Nigerians and minimise out-of-pocket medical expenses by individuals.
“GIFSHIP is a laudable programme. It formalises the informal sector bringing everyone on board. The premium is affordable and the benefit package is comprehensive. NHIA-GIFSHIP is the vehicle to drive UHC in the country,” Eteng said.
Dr Michael Cole, President, Lagos Chamber of Commerce and Industry, who was represented by Engr Leye Kupoleye, the vice president of the LCCI, in his opening remark to declare NHIA a special day at the fair open, noted that the coronavirus pandemic (COVID-19) had thrown up a lot of challenges globally and at the same has provided with new ways of doing business.
He observed that the less than 10 per cent of health insurance of the Nigerian population of over 200 million people is not encouraging as the government alone cannot fund its healthcare system, adding that the informal sector is not well captured into the scheme.
GIFSHIP was redesigned to extend healthcare coverage to organisations, political office holders, donor agencies, multinational corporations, philanthropists, and Nigerians in the diaspora in the overall efforts towards ensuring that every Nigerian has access to quality and affordable healthcare.
Based on the terms, the eligibility And Membership shall include i. Small-scale enterprises with less than 10 staff members, non-cohesive groups of persons, such as associations, unions, and institutions outside the Organised Private Sector (OPS), self-employed individuals, families, and groups
Others are retirees and retiree associations, diaspora groups, foreigners living in Nigeria and adopted persons, such as those paid for by members of the National Assembly and Philanthropists, etc.
Some of the illnesses covered under the initiative include proper history taking, examination and routine laboratory investigations to help reach a diagnosis. Laboratory investigations include malaria parasite, WBC, Hb or PCV, urinalysis, stool and urine microscopy, blood film for microfilaria, pregnancy test (urine), Blood grouping, Blood Sugar, and Widal test.
Others include paediatrics, feeding problems and nutritional services, Treatment of common childhood illnesses (malaria, other febrile illnesses, vomiting, uncomplicated diarrhoeal diseases, uncomplicated malnutrition, failure to thrive, measles, upper respiratory tract infections, uncomplicated pneumonia and other childhood exanthemas, simple skin diseases, and viral illnesses).
Other illnesses as may be listed from time to time by the NHIS; Obstetrics & Gynaecology; Acute pelvic inflammatory diseases o Vaginal discharges o Routine maternity care for all pregnancies (ante-natal, delivery & post-natal) except where complications exist. Other illnesses may be listed from time to time by the NHIS and much more.
A cross-section of people who spoke to our correspondent in Abuja said they liked the idea of a health insurance scheme but decried that individual or family contributors may not get the desired protection from poor services compared to corporate subscribers.
Mr Anthony Aba, a businessman in Abuja, asked about the safety nets to protect individual contributors to a health insurance scheme. He said most times at the hospitals, patients under the health insurance scheme don’t get quality customer service as they are meant to. He added that often patients are made to wait for hours to see a doctor.
He also added that some of the patients would hardly get the prescribed drugs at the health insurance pharmacy while the out-of-pocket patients get the same drugs at the general pharmacy because they are paying.
Another informal sector player, Abdulateef Rafiu, a mechanic, said in as much as the idea is good, he is not even aware of the opportunities. He thus called for more awareness by the promoters of the initiative.
Eze Onyekpere, in an article titled National Health Insurance Authority Act and Mandatory Health Insurance, argued that there are a plethora of reasons in support of compulsory and universal health insurance schemes in Nigeria.
He listed some to include; “achievement of universal health coverage, financial risk protection in accessing healthcare, introducing equity in financing healthcare and facilitating the implementation of the minimum core obligation of the state on the right to health.”
Others are to “reduce the financial burden on the government, guarantee sustainability and credibility of health financing, facilitate the whole-of-society approach to health, and set the building block for a vibrant and healthy population.”
Furthermore, he said, the health insurance is a means of poverty eradication, reducing inequality, and uplifting the low income in the society.