Health insurance plays a crucial role in safeguarding individuals against the financial burden of medical expenses. It spreads the risk across a larger population, allowing people to access healthcare without facing significant financial strain. By assessing the collective risk and expenses related to healthcare, insurers can establish a financial framework, such as monthly premiums or payroll taxes, to fund the healthcare benefits outlined in the insurance policy.
The National Health Insurance Scheme (NHIS) in Nigeria, introduced in 2005, aims to provide universal access to quality healthcare services. It operates as a social health insurance program, utilizing pooled funds contributed by participants to cover the healthcare expenses of contributors. Through regular fixed payments, participants contribute to a common fund, which is then used by Health Maintenance Organizations (HMOs) to cover the medical needs of individuals. This pre-payment model fosters risk-sharing, enhancing resource mobilization and promoting fairness. Consequently, it has become one of the most widely adopted healthcare financing approaches worldwide.
NHIS also oversees private health insurance schemes operated by HMOs. These schemes function as a social security system, ensuring individuals receive necessary healthcare services upon making regular contributions. The National Health Insurance Scheme offers several advantages, including:
Risk Sharing
National Health Insurance Schemes promote risk sharing, allowing individuals to share the financial burden of healthcare expenses. By spreading the risk across a larger population, health plan premiums can remain stable and affordable.
Improved Resource Mobilization
These schemes pool funds contributed by participants, creating a centralized resource pool for healthcare needs. This ensures the availability of funds and facilitates effective resource allocation for health projects.
Health Equity
National Health Insurance Schemes prioritize equity in health by treating all enrollees equally, regardless of social, economic, or demographic factors. This approach ensures that everyone has a fair opportunity to access healthcare services.
Reduced Costs
The scheme helps reduce the reliance on out-of-pocket payments for healthcare, which can pose a significant burden on households. By providing affordable coverage, it alleviates the financial strain on individuals and families.
Protection from Financial Barriers
National Health Insurance Schemes protect families from financial barriers to healthcare. By providing affordable coverage, individuals can access necessary medical services without worrying about the cost.
Improved Services
Since the introduction of the scheme, there has been a marked improvement in the healthcare system, including better coordination, reduced fragmentation, enhanced infrastructure, and improved quality of care.
Reduction in Maternal Mortality
National Health Insurance Schemes play a vital role in reducing maternal mortality rates. By ensuring access to essential healthcare services, particularly in developing countries with high maternal mortality rates, these schemes contribute to the global effort of reducing maternal deaths.
Benefits of National Health Insurance Scheme
Benefits of the National Health Insurance Scheme:
- Out-patient Care: Enrollees receive comprehensive out-patient care, including necessary consumables, following the NHIS Standard Treatment Guidelines and Referral Protocol.
- Prescribed Drugs and Diagnostic Tests: The scheme covers prescribed drugs, pharmaceutical care, and diagnostic tests as listed in the NHIS Drugs List and NHIS Diagnostic Test Lists.
- Maternity Care: Insured enrollees in the Formal Sector Programme are entitled to ante-natal, delivery, and post-natal care for up to four pregnancies ending in live births. Additional care is provided in the case of stillbirth.
- Coverage for Live Births: All live births are covered during the post-natal period of twelve weeks from the date of delivery. The scheme also covers preterm/premature babies for twelve weeks.
- Preventive Care: Enrollees have access to preventive care, including immunization following the National Programme on Immunization. Adult immunizations such as HPV and Hepatitis are also covered. Health and family planning education are part of the package.
- Specialist Consultations: Enrollees can consult with various specialists, including physicians, pediatricians, obstetricians, gynecologists, general surgeons, orthopedic surgeons, ENT surgeons, dental surgeons, radiologists, psychiatrists, ophthalmologists, and physiotherapists.
- Hospital Care: In the event of a referral, enrollees receive hospital care in a standard ward for a cumulative stay of up to 21 days per year.
- Eye Examination and Care: The scheme covers eye examinations and care, including the provision of low-priced spectacles (excluding contact lenses).
- Prostheses: Enrollees have access to a range of prostheses produced in Nigeria.
- Dental Care and Annual Checkup: Dental care, excluding those on the exclusion list, is covered. Enrollees are also entitled to an annual medical checkup unrelated to illness.