Significant Challenges In Health Insurance By Odiawa Ai
In recent months, there has been a significant advancement in the health insurance landscape, thanks to the National Health Insurance Authority (NHIA). The enhancements to two crucial financial incentives for health providers promise to bolster the quality of care and sustainability of health services across the country.
One of the most notable changes is the substantial increase in the ‘capitation fee’—the monthly payment provided by the government to Health Maintenance Organizations (HMOs) and other healthcare providers for each enrolled patient, irrespective of the actual cost of services rendered. This fee has seen an impressive rise of 93%. Such a substantial increase is expected to relieve some of the financial pressures faced by healthcare providers, allowing them to allocate resources more effectively and enhance service delivery to patients.
In addition to the capitation fee, there has been a remarkable adjustment to the fee-for-service structure, which covers separate payments for specific medical procedures. This component has experienced a staggering increase of approximately 378%. This adjustment marks the first review of fees in over a decade, signaling a much-needed response to the evolving economic landscape and the demands of quality healthcare delivery.
These enhancements are not merely financial adjustments; they are pivotal components of the current administration’s sector-wide strategy aimed at improving the nation's health indices. Under the guidance of Coordinating Minister Muhammad Pate, the Federal Ministry of Health has been actively working to address long-standing challenges in the healthcare sector.
What sets these improvements apart is the rigorous stakeholder consultations and actuarial analyses that preceded the reviews. This careful preparation ensures that the new rates are not only realistic but also sustainable in the long term. The meticulous approach taken by the NHIA demonstrates a commitment to involving diverse perspectives in the decision-making process, ultimately fostering a more robust health insurance system.
The increases in both the capitation fee and fee-for-service rates are particularly significant in light of the challenges that health providers have faced in recent years. The failure of successive governments to adjust these fees in the face of economic downturns and rising inflation had created a disincentive for many providers. Complaints about shrinking margins and the inability to maintain a high standard of care for enrolled patients had become prevalent.
The recent adjustments signify a long-overdue recognition of the complexities involved in delivering healthcare in today’s economic climate. The administration’s proactive stance in addressing these issues deserves commendation, as it not only aims to improve the financial viability of health service providers but also seeks to enhance the overall quality of care that patients receive.
The recent statements from the Director General of the National Health Insurance Authority (NHIA), Kelechi Ohiri, highlight the urgent need for healthcare providers to elevate service quality. The welfare of patients must be the foremost consideration, as improved service standards in hospitals and health centers are essential for encouraging more Nigerians to enroll in health insurance programs.
Despite the potential of a population nearing 200 million, health insurance enrollment figures remain dishearteningly low. Twelve years after the flag-off of the National Health Insurance Scheme, less than 10% of Nigerians are currently covered. However, there is a glimmer of hope; in the past nine months, we have seen an increase of over two million Nigerians signing up for health insurance, bringing the total coverage to approximately 19.18 million by the third quarter of 2024. While this uptick is encouraging, it is clear that we still have a long journey ahead.
One of the most significant developments in 2024 was the achievement of full nationwide coverage of state social health insurance agencies. With Akwa Ibom becoming the last state to join the ranks, all 36 states and the Federal Capital Territory (FCT) are now equipped with operational health insurance schemes. This milestone presents a unique opportunity for the NHIA to implement its strategy of close collaboration with sub-national agencies. By fostering these partnerships, we can drive improved service delivery and enhance enrollment rates across the country.
With alarming health statistics highlighting the challenges we face, it is crucial that we come together to seek solutions. Currently, our nation grapples with a life expectancy of just 55 years for men and 56 years for women. Additionally, the under-five infant mortality rate stands at a staggering 104 deaths per 1,000 live births, and maternal mortality rates are equally concerning, with 814 deaths per 100,000 live births. These figures underscore the pressing need for comprehensive health insurance reforms and initiatives.
One of the primary goals of health insurance should be to support disadvantaged groups, ensuring that the most vulnerable populations receive the care they need. By leveraging available mechanisms and funds, we can significantly reduce suffering and prevent unnecessary deaths. This commitment is particularly evident in the implementation of Comprehensive Emergency Obstetric and Newborn Care (CEmONC) programs, which provide essential services to mothers and newborns. The Free Fistula Programme, coordinated by the National Health Insurance Authority (NHIA), is a notable example of this effort. Since its launch in June 2024, this program has provided much-needed support to 1,629 beneficiaries across 42 healthcare facilities nationwide, highlighting the importance of targeted initiatives in improving health outcomes for disadvantaged groups.
While these initiatives are commendable, the journey toward achieving universal health coverage by 2030 remains challenging. The recent appointment of Ibrahim Oloriegbe as the new Governing Council Chairman of the NHIA is a promising development. Oloriegbe's prior experience as the Senate Health Committee Chairman, where he played a pivotal role in the passage of the NHIA Act, positions him well to lead the agency in navigating the complexities of health insurance reform. His leadership will be vital in ensuring that the goals of the NHIA align with the broader objective of improving health statistics and access to care for all citizens.
To make universal health coverage a reality, it is imperative that we address a few
critical issues:
Accessibility and Affordability: Health insurance must be accessible and affordable for all citizens, particularly those in low-income communities. This involves not only expanding coverage but also ensuring that health services are within reach for those who need them most.
Quality of Care: Improving the quality of care within health facilities is essential. This requires ongoing training for healthcare professionals, investment in infrastructure, and the provision of necessary medical supplies and equipment.
Public Awareness and Education: Education about available health insurance options and the importance of seeking care must be prioritized. Public awareness campaigns can empower individuals to take charge of their health and utilize the resources available to them.
Monitoring and Evaluation: Continuous monitoring of health outcomes and the effectiveness of health insurance programs is crucial. This data-driven approach will help identify gaps and inform future policy decisions.
The advantages of increased enrollment are multifaceted. A surge in the number of insured individuals will lead to greater funding for health initiatives, enabling investments in healthcare infrastructure and services. Moreover, when more Nigerians have access to health insurance, we can create the necessary synergies to deliver better healthcare services to a larger segment of the population. Health insurance is not just a financial safety net; it is the most efficient, sustainable, and democratic means of ensuring access to healthcare for all citizens.
As we move forward, it is crucial for healthcare providers to prioritize quality and patient welfare. The responsibility lies not only with the insurers but also with the health facilities to ensure that the services rendered meet the expectations of the populace. By improving service standards, we can foster trust in the system, encouraging more individuals to take the step towards enrolling in health insurance.
While the current enrollment figures may reflect challenges, the recent progress in health insurance coverage in Nigeria indicates a positive trajectory. With the full complement of state health insurance agencies now operational, we are poised to leverage this framework to enhance service delivery and drive enrollment. It is imperative for all stakeholders—government, healthcare providers, and the public—to work collaboratively towards making health insurance accessible and beneficial for every Nigerian.