Poor Health Services Amid Nigerians Entitlement Under National Insurance Act

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The delivery of health care in Nigeria has faced major challenges in achieving universal health coverage. While significant progress was made in the first two decades after the country’s independence in 1960, the economic downturn resulting from the fall in the price of oil on which Nigeria depended led to a series of twists and turns in the health sector. . Health policies were then influenced by external forces, and the adoption of the structural adjustment program marked the transition from a predominantly social regime to the introduction of a user fee and the resulting proliferation private health care provision.

In recent times, since 2006, the Nigerian government has developed the National Health Promotion Policy (NHPP) to build the health promotion capacity of the national health system to deliver health care that is promotive, protection, prevention, restoration and rehabilitation to every citizen of the country. country.

The vision of the NHPP is universal health coverage for all Nigerians. The mission is to provide health actors with a comprehensive framework to harness all resources for health development towards the achievement of UHC as articulated in the National Health Act in tandem with the SDGs.

In improving access to quality health services, the World Health Assembly in 2005 increasingly called on countries to prioritize universal health coverage. This remains a viable means of providing appropriate promotion, prevention, treatment and rehabilitation services at an affordable cost to all.

In Nigeria, the challenge of UHC is critical, especially to ensure financial protection and access to necessary health care for those outside the formal sector. This is due to limited tax revenue in the country, equity and efficiency issues associated with contributory schemes for the informal sector. The burden of health expenditure is mainly attributed to common endemic diseases; they constitute the majority of public health problems due to their recurrent nature and are the main causes of death.

The high level of out-of-pocket expenditure and the scarcity of insurance mechanisms to pool and manage risk pose a major challenge to financing health care in Nigeria. The low financial capacity of consumers to pay for necessary health services results in inequitable access to health care. This has prevented many Nigerians from accessing needed health services, leading to loss of productivity, poverty, poor health outcomes and preventable deaths.

In order to address the resumption of these trends, the Center for Social Justice (CSJ) Nigeria, with support from the Strengthening Civic Advocacy and Local Engagement Program of the United States Agency for International Development (USAID-SCALE), has worked to improve the realization of the right to health in Nigeria since the beginning of this year.

It is commendable that the Nigerian President, Muhammadu Buhari, has signed into law a law repealing the National Health Insurance Scheme Act 1999 and establishing the National Health Insurance Authority.

According to the Nigerian Health Watch, the new law is a big step towards universal health coverage in Nigeria as, through the law, health insurance is now compulsory for all Nigerians. This could mean that more than 70% of Nigerians who pay out of pocket for health care, many of whom are pushed into poverty, could benefit from nationally compulsory health insurance.

There are some very commendable provisions in the new law that are worth mentioning. First, every Nigerian is now required by law to have health insurance. Specifically, the law requires all public and private sector employers and employees with five or more employees, informal sector employees and all other residents in Nigeria to have health insurance.

This is an improvement on the National Health Insurance Scheme Act 1999, the purpose of which was to “provide health insurance to enable insured persons and their dependents to benefit from health services quality and cost-effective prescription drugs”, and a major step towards achieving Universal Health Coverage (UHC).

The NHIS Act 1999 established a scheme the purpose of which was to provide health insurance to insured persons and dependents who were entitled to it.

But the National Health Insurance Authority Act 2022 created an oversight and regulatory body for health insurance schemes and more clearly defined the roles of this authority to: (a) promote, regulate and integrate health insurance schemes; (b) Improving and harnessing private sector participation in the delivery of health care services; and do other things that will help the authority to achieve universal health coverage for all Nigerians.

One of the ways in which the NHIA will likely integrate health insurance schemes in Nigeria is through the establishment of an extensive information and data management system which, by law, should be established in conjunction with other other information management organizations in Nigeria and all states.

Two parts of the 2022 NHIA Act address third-party administrators. The first expands the role of third-party administrators and the second restricts the actions of health maintenance organizations (HMOs). Considering the fact that HMOs are effectively Third Party Administrators (TPA), these two stipulations may seem contradictory at first glance. But we break it down a bit more below.

First, third-party administrators are intermediaries to facilitate claims between the insurer and the insured. TPAs were neither defined nor mentioned in the NHIS Act of 1999. This shortcoming meant that HMOs were the only recognized administrators of health insurance outside the national scheme, which limited the effectiveness of health service delivery. health. In the newly signed law, TPAs ​​have been expanded to include: HMOs, mutual health insurance and other health insurance TPAs.

A summary of the new law shows that the NHIA has been given a wide range of expanded functions that enable the Authority to serve as a regulator, implementer, investor and insurer of practices and schemes. health insurance in Nigeria.

Given continued advocacy, intense technical and public sessions and debate, the new law clearly states that the NHIA is empowered to serve as the regulator of health insurance plans in the country. Many public health insurance schemes have been created to provide services to residents. These needed a governing body which the NHIS was simply not empowered by law to provide. Thus, the NHIA will now promote, regulate and integrate all health insurance schemes in Nigeria.

The NHIA will also regulate, accredit, and register HMOs and other third-party administrators since it has been empowered by this new law as the licensing body to perform these oversight functions for TPAs.

This new law aims to make the NHIA a sound authority that will insure registered private health insurance companies through a security deposit that these HMOs are required to pay prior to registration. This feature ensures that in the event of financial hardship or the cessation of operations of a health insurance scheme or private health insurance organization for any reason, affiliates remain insured and do not incur financial ruin. Similar to how the Central Bank of Nigeria (CBN) and the Nigeria Deposit Insurance Corporation (NDIC) insure banks to protect user funds.

As an investor, NHIA simply authorizes NHIA to invest funds that are not immediately expended in federally approved securities, at the discretion of the Board of Directors. The sustainability of health insurance scheme funding continues to be the focus and it is expected that by investing funds at the NHIA level, schemes will have a support system for emergency funding. .

The new NHIA law stipulates the creation of a new fund for vulnerable groups and retains the NHIA fund. The Vulnerable Groups Fund will be created to ensure the subsidy of health insurance coverage for vulnerable people and the payment of health insurance premiums for the indigent.

Equally interesting to note are the sources of this fund; the Basic Health Care Provident Fund (BHCPF), the health insurance tax, the special intervention fund allocated by the government, interest on investments and others – grants, donations, donations and contributions. The telecom tax previously included in the invoice was subsequently removed.

A key point to note is the need to clarify who are the vulnerable and indigent people who will benefit from this fund. Although the law states that this will be determined by the board (and those with private health insurance are not eligible to benefit from the fund), the details of their identity must be clarified and made public.

The new law retains the NHIS fund provided for in the NHIS Act 1999. All expenditure will be made from this fund, including staff salaries, allowances and benefits. It will be funded by allocations from the federal government, donors, private insurance charges, fees, fines and commissions, donations and contributions. It may also be invested in securities and deposits, with interest accruing to the fund. Own accounts on the management of this fund will be presented to the Minister of Health at the latest 6 months after the following year. The NHIA also continues to be tax-exempt.

Another essential part of the law to note is that the NHIA must undertake alone or in collaboration with others sustained and ongoing public education about health insurance. As we describe in this 2017 article, the NHIA already has a ready group of collaborators among universal health coverage advocates who have supported continued public education about health insurance in states and communities. A good example is Nigeria Health Watch’s Health4AllNaija Advocacy which since 2017 has been working to raise awareness about health insurance and its benefits to community members in various states while advocating and providing technical support around UHC legislation.

Ultimately, it is good to see that many of the key recommendations made regarding the NHIS Act have been reflected in the NHIA Act. We will continue to monitor and support the implementation to ensure that we achieve the right to health for all Nigerians.

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