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Nigeria to reassess Health Insurance fees

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By Abiodun Okunloye

NHIA aims to improve Nigerians' access to health insurance services and quality.

Dr. Kelechi Ohiri, the Director-General of the National Health Insurance Authority, has announced that a comprehensive evaluation of capitation fees that Healthcare Providers receive is underway to enhance the accessibility and quality of health insurance services for the people of Nigeria. Monthly payments, known as capitation fees, are paid to healthcare providers like hospitals, clinics, and physicians for each patient enrolled in a specific plan as outlined in a contract. Addressing a panel on Nigerian insurance availability, he emphasised the concerns raised by healthcare providers participating in the program regarding capitation fees.

He stressed the importance of addressing this issue promptly, as the fees have remained unchanged for a significant time. When they returned to work at the NHIA, one of their initial tasks was conducting actuarial reviews, as they had noticed that Tariffs had not been reviewed in quite some time for the sector. These reviews began in February. Ohiri states that the goal is to gather data and analysis to reassess tariffs within the nation. Additionally, from an actuarial standpoint, it is essential to determine the affordable scope of a fundamental service package.

Government has set up funds for vulnerable groups’ needs.

This will enable individuals to clearly understand the costs when seeking medical treatment at a hospital. The government created the Vulnerable Group Fund to address the need for care coverage for Vulnerable Populations. This fund acknowledges that health insurance can either be funded through individual prepayment or by the government on behalf of those unable to afford it. Enhancing the existing enrolment number by about 16 million individuals, representing 7 percent of the country’s population, is a significant national challenge.

The new NHIA Act in Nigeria has given the agency more power to tackle the issue of low insurance coverage. With only 7 percent of the population currently insured, the mandatory law aims to pave the way for universal coverage for everyone in the country. The ultimate goal is to steadily increase the percentage of insured individuals beyond the current number. By pushing the boundaries and implementing new strategies, the NHIA hopes to significantly expand insurance coverage and ensure more people can access the services.

Better payment for practitioners can enhance service quality.

As part of its thorough evaluation, the NHIA is considering several significant fee adjustments. These changes involve adopting a pricing structure where rates vary based on the level of care patients seek and raising monthly payments to healthcare professionals based on the kind and complexity of services provided. Better pay for practitioners could encourage them to provide patients with higher-quality, more thorough care. Because clinicians will have more resources to address patients’ needs, patients should experience increased access to critical services, shorter wait times, and overall higher levels of patient satisfaction as a result of these changes.

In addition, the Vulnerable Group Fund aims to fill the gap in care access for people who cannot pay insurance payments. The fund, financed by government allocations and might be enhanced by contributions from foreign donors and collaborations with the corporate sector, intends to offer full coverage or Subsidies to vulnerable groups, such as low-income families, the elderly, and individuals with disabilities. The fund is anticipated to improve outcomes, early sickness identification and treatment, and decrease unnecessary death rates by lowering these populations’ financial barriers to care access.

Related Article: Health insurance now mandatory—NHIA 

To surpass the current enrollment rate, they are implementing various strategic initiatives. These include the implementation of streamlined registration procedures to make it simpler for people to sign up, partnerships with local leaders to encourage enrollment in underprivileged and rural areas, and national public awareness campaigns to inform citizens about insurance advantages. Enrollment incentives like lowered premiums or expanded benefits are also being considered. But there are still a lot of challenges to overcome, like financial limitations, cultural opposition to insurance, and logistical difficulties in isolated areas.


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