Community mobilization, greater political will and a re-appraisal of capitation paid to healthcare providers by Health Management Organisations (HMOs), have been recommended as some of the solutions to the challenges of Health Insurance in Nigeria.
The recommendations were made at a panel discussion of the Clinical Management Conference, which took place on the sidelines of the just concluded Medic West Africa 2024, held at Landmark Centre, Lagos, from 17th-19th of April.
With the theme The Good, Bad and Ugly Side of Healthcare Insurance in Nigeria, the conference was hosted by Informa Markets, a United Arab Emirates (UAE)-based company, in partnership with the Association Of Nigeria Private Medical Practitioners (ANPMP).
According to one of the panel discussants, Dr. Olayiwola Bello, Chief Medical Director (CMD) of Subol Hospital, Alimosho, Lagos, while the federal government’s efforts at ensuring Universal Health Coverage (UHC) through the creation of the National Health Insurance Scheme (which later became the National Health Insurance Agency) should be applauded, the entitlement mentality of enrollees and low capitation of healthcare service providers are some of the industry’s challenges.
Dr. Bello also stated that competition among healthcare providers and the unwillingness of Health Maintenance Organisations (HMOs) to review premiums have encouraged underpricing and the payment of insufficient fees to health providers. Stressing that quality has a price, he advised that tariffs should be reviewed, so that enrollees can derive greater benefits from health insurance, while quality programmes should be developed for providers. According to Dr. Bello, there should be laws and benchmarks for tariffs.
The four-man panel also included Dr. Isaac Feludu, Chief Medical Director at DeltaCrown Hospital, Lagos, who noted that there has been much focus on the National Health Insurance Agency (NHIA), while the inadequacies and underhand tactics of HMOs are overlooked. He noted that most health insurance enrollees in Nigeria are civils servants and while only the government pays its fraction of the premiums, civil servants are yet to start paying.
Lamenting that drug tariff is nothing to write home about, Dr. Feludu advised that tariffs paid by state and federal governments should be at par and enough for capitation, in order not to short-change healthcare providers.
Another speaker, Dr. Austin Aipoh, President, Healthcare Providers Association of Nigeria (HCPAN), maintained that stakeholders in the health insurance industry would be happy, if half of Nigeria’s population could be enrolled in health insurance schemes.
Explaining that a greater part of healthcare services in a health insurance scheme should be dispensed to enrollees at primary healthcare centres, rather than tertiary healthcare institutions, he noted that more achievements could be made in the health insurance industry, if the government showed greater political will. Dr. Aipoh also called for greater community mobilization to raise awareness for health insurance at the grassroots.
In her contribution, Dr. (Mrs.) Adenike Olaniba, Chief Medical Officer of Olaniba Memorial Hospital, Lagos, stated that some countries in sub-saharan Africa have achieved greater successes in health insurance, noting that Ghana’s strength in health insurance is a result of the community mobilization of its citizens. She added that Nigeria should embark on such community mobilization, as health insurance is volume-driven. .
She concluded that Nigeria may not attain its health insurance goals, if awareness is not created at the grassroots. According to her, lack of awareness at the grassroots will always lead to an inequitable distribution of enrollees in Nigeria’s health insurance.