Health Maintenance Organizations In Nigeria
Prior to the growth of Health Maintenance Organizations In Nigeria, a national health policy was adopted in 2006 as way of strengthening the health care system in Nigeria. The National health policy was created with the aim of ensuring that a formidable health financing system with the capacity to improve the health services in Nigeria is attained. The plan includes a re-designed National health insurance scheme that protects citizens against high costs of treatment, a fair financing of health care providers and providing health standards that meet the citizen’s expectations.
How is the NHIS funded? The funds of the NHIS are gotten from the contributions made by members based on their basic salary. Funds from the formal sector are premiums of up to 15% of a workers basic salary. The employer contributes 10% while the employee pays 5% adding up to 15%. This coverage that the members are provided with covers them, their spouse and 4 children who are under the age of 18 years. If supplementary services are needed, an employer can negotiate with an HMO and pay for those extra services. Members of the informal sector are expected to make monthly contributions to the NHIS. There are people who are exempted from paying contributions but enjoy these services, they include: those with disabilities, the elderly or aged, veterans and the poor.
How does the NHIS work? A contributor or member registers with an NHIS approved Health maintenance organization, a privately or publicly held limited liability company registered by the scheme to provide health care services to its members. After registering with an HMO, the members or contributors again register with private health care providers of their choice as long as the hospitals are listed on the HMO approved list of health providers. An identity card with an identification number is given after the contributor registers. Upon commencement, the member is allowed to change their primary care physician if they are not satisfied with the services being offered to them.
The NHIS in Nigeria has several benefit packages to its workers in the formal sector which includes:
a) Out-patient care, with necessary consumables being included
b) Prescribed drugs and diagnostic tests to be provided as listed on the National essential drugs list and diagnostic tests list.
c) Maternity care not exceeding 4 live births for every insured member.
d) Preventive care that includes; immunization, family planning, health education, post-natal care and antenatal.
e) Hospital in-patient care in a standard ward of up to 15 days in a year.
f) Eye examination and care with the exclusion of spectacles and contact lenses.
g) A range of prostheses which is limited to artificial limbs produced in Nigeria.
h) Preventive dental care and pain relievers that includes; consultation, dental health education, amalgam filling, and simple extraction.
The NHIS has several goals. It wants to watch over the Health Maintenance Organizations In Nigeria, ensure that all Nigerians have access to quality health care services, cover individuals from costly medical care, ensuring equitable distribution of health care services in the country and to maintain high standards of health care services.