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Challenges, solutions to effective health insurance services in Nigeria

No one plans to get sick or hurt, but most people need medical care at some point in their lives.

With the rising costs of medical treatments and the prevailing economic situation, health insurance has become a much-needed financial cushion that helps individuals and families afford necessary medical care without financial strain.

However, this is fast becoming an illusion for many Nigerians, especially enrollees under the National Health Insurance Authority (NHIA) and some health management organizations (HMOs).

The News Agency of Nigeria (NAN) reports that enrollees’ dissatisfaction bordered on denial of treatment, delay in receiving approval for treatment at health facilities, non-availability of most prescribed drugs, low-quality drugs, and poor services, among others.

The National Health Insurance Scheme is a body set up by Decree 35 of 1999 (now Act 35), operating as a public-private partnership and directed at providing accessible, affordable, and qualitative healthcare for all Nigerians.

On May 24, 2022, it was officially gazetted by the Federal Government as the National Health Insurance Authority (NHIA).

The NHIA was given new and enlarged duties that enable it to operate as a regulator, implementer, investor, and insurer of health insurance policies and programmes in the country.

With the establishment of the NHIA Act, every Nigerian is now mandated to get health insurance.

The scope of NHIA coverage paid healthcare benefits for the employee, a spouse, and four biological children.

Insurance firms called HMOs are licensed by the NHIA to oversee the delivery of quality healthcare services using various health institutions.

In spite of initiatives designed to protect Nigerians from financial hardship arising from healthcare, some enrollees decried the low-quality medical services rendered under NHIA services.

A journalist with Voice of Nigeria (VON), Mrs. Evelyn Godwin, lamented the non-availability of prescribed drugs at the NHIA pharmacy at Isolo General Hospital, Lagos.

Godwin said that she had never been given up to 50 per cent of the prescribed drugs by the NHIA pharmacy, adding that even the few drugs available were usually unbranded ones.

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“I went there recently, and the doctor prescribed some malaria drugs and high blood pressure drugs, but the NHIA pharmacist referred me to the general fee-paying pharmacy to buy as they do not have the drugs.

“The development is quite discouraging; imagine after transporting yourself to the hospital and making efforts to see a doctor, then, at the end of the day, little or none of the prescribed drugs will be given to you,” Godwin said.

Similarly, Mr. Jude Akubuike, a staff member of National Orientation Agency (NOA), said there was a need to improve on the quality of drugs dispensed at NHIA pharmacies

He expressed regret that NHIA health providers never had drugs prescribed by doctors, but the pharmacy would provide a lower-quality drug or refer enrollees to buy the drugs outside.

Akubuike said there was a need for the scheme to create awareness about enrollees’ rights as well as the responsibilities of the HMOs, urging NHIA to develop an efficient system that would ensure enrollees’ satisfaction.

He also called for good relationships and proper monitoring between the HMOs and the healthcare providers to bridge service gaps.

Another enrollee, Mrs. Veronica Nkume, attested that the scheme had benefited her family, particularly in the area of child delivery services.

According to her, she successfully gave birth to her three children under the scheme, during which she paid only 10 percent of her medical bills.

“Both cesarean section (CS) delivery and normal vaginal child delivery are well covered by the NHIA,” she said.

Commenting, Wale Oladigbolu, National Chairman, Association of Community Pharmacists of Nigeria (ACPN), urged the government to make health insurance effective to relieve Nigerians of the high costs of medicine.

Oladigbolu lamented that, globally, Nigeria has the highest out-of-pocket spending on healthcare, with citizens bearing more than half of their healthcare costs.

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“If health insurance works well, nobody will care about the increase in the price of drugs when you pay only 10 percent for both treatment and drugs at the hospital.

“South Africa has a population of less than 60 million and a pharmaceutical industry worth over three billion dollars because their health insurance is very effective.

“Nigeria can only boost a pharmaceutical industry worth over one billion dollars.

“The government needs to ensure that health insurance works because healthcare should not be based on whether people can afford it or not. It should be a fundamental human right,” Oladigbolu said.

Reacting to the issues, Clement Olaifa, Deputy National President, Healthcare Providers Association of Nigeria (HCPAN), called for the review of the nation’s health insurance policies to deepen uptake and growth of the industry.

Olaifa noted that the NHIA remains the gateway to achieving universal healthcare coverage, calling for prompt resolution of complaints to enable it to deliver its mandate in line with global best practices.

According to him, issues of sincerity of the managers of health insurance should be addressed to
improve public trust in health insurance.

He emphasised the need for collaboration between regulatory authorities and stakeholders to drive quality, accessible, affordable, equitable, and efficient healthcare that would reduce out-of-pocket expenditure.

Olaifa stressed that capitation should reflect current economic realities to sustain and expand access to quality healthcare services.

Similarly, Dr. Leke Oshunniyi, Chairman, Health and Managed Care Association of Nigeria (HMCAN), maintained that an appropriate premium should be integrated into the NHIA system to enhance its effectiveness for its teeming enrollees.

Oshunniyi, however, said most private HMOs in the country did not have cost-sharing schemes like the copayment mechanism operated by NHIA within their benefit designs, thus covering the total cost of treatment for their enrollees.

He advocated for the introduction of a copayment mechanism for private sector enrollees, noting that it would make enrollees cost-sensitive and encourage them to work with their physicians on affordable treatment options.

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“For example, a branded co-amoxiclav is called Augmentin. But the cost of Augmentin went up above N30, 000 in January, whereas its generic version cost N4,000.

“Meanwhile, the whole premium paid by an enrollee under a private health insurance plan is less than N100, 000 per annum.

“One drug alone from one encounter, costing between N30,000 and N40,000, doesn’t make economic sense.

“Everywhere in the world, even the United Kingdom, which spends $160 billion on their health system, uses generic drugs,” he said.

Oshunniyi stressed that generic and branded drugs are supposed to be effective in managing diseases.

He advised the public to disabuse their minds of the belief that generic medicines are low quality, affirming that generic medicines are required to be the same as brand-name medicines in dosage, safety, effectiveness, strength, stability, and quality.

“What we need to do is ensure that the drugs entering the country are what they say they are. If a product says it’s 1,000 or 500 grams of paracetamol, that’s what you should find there,” he said.

Oshunniyi noted that there are agencies saddled with the responsibility of ensuring the efficacy, safety, and standard of medicines, stressing that such functions don’t fall under their purview.

He said that HMCAN was running public and private health insurance services, adding that members of the association are committed to improving quality service delivery in spite of medical inflation.

Also, Dr. Kayode Adesola, National President, Association of Nigerian Private Medical Practitioners (ANPMP), said that the NHIA has an agreement with pharmaceutical companies to ensure quality, affordable, and accessible medicine for enrollees.

Adesola said that efforts should be made to strengthen and sustain the pact.

The experts opined that if these recommendations are explored, achieving the universal health coverage target by 2030 becomes a possibility. (NANFeatures)

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