Nigerian National Health Insurance Scheme
Since its enactment in 1999, the Nigerian National health insurance scheme(NHIS) only became operational in June, 2005. The main reason for its establishment is the provision of health care services by giving a sustainable alternative source of funding health care services. The NHIS is a social security system that offers financial security to the citizens against unanticipated ill health. The scheme has different programmes that cover the informal sector workers, formal sector workers and vulnerable groups.
The National Health Insurance Scheme created several programmes that were meant to cover different segments of the society as a way of ensuring that every Nigerian citizen has access to good health care services. The formal sector social health insurance programme which consists of the public sector, coordinate the private sector & armed forces, the police and other uniformed services. The informal sector social health insurance programme is made up of the community based social health insurance programme and voluntary contributors social health insurance programme. Last but not least, the vulnerable group social health insurance health programme is planned to offer health care services to persons due to their weak physical state and their inability to take part in any useful economic activity.
The Nigerian National health insurance scheme (NHIS) has a benefit package that covers most of the Nigerian healthcare requirements. Health care providers that are in the scheme, provide the following to the contributors:
- Provides preventive care with the inclusion of immunization as it applies in the National programme on immunization, health education and family planning education.
- Out-patient care with the inclusion of necessary consumables.
- A range of prostheses
- Provision of preventive dental care, with consultation, amalgam filling, dental health education and easy extraction all being included.
- Examination of the eyes and care but excluding spectacles and lenses.
- Provision of maternity care with a maximum of four live births for every insured contributor in the formal sector plan.
- Consultation with provision of specialists such as; pediatricians, physicians, psychiatrists, obstetricians, physiotherapists, general surgeons, dental surgeons, gynecologists, and radiologists among others.
- Offer hospital care in a standard ward for a stay limited up to 21 days per year.
The Nigerian National health insurance scheme works as below:
This scheme is in charge of registering health maintenance organizations and health care providers in the country. It issues them with the right guidelines for the scheme and also determines after negotiation, capitation and other payments due to the health maintenance organizations and health care providers. The HMOs might be privately or publicly owned, and are given the duty of collecting contributions, making payments to health care providers for services provided and ensuring quality assurance. Registered private & public hospitals and clinics are the ones that provide health care services. Enrollees have to register through a health maintenance organization and thereafter select a primary health care provider which acts as their first contact provider to the scheme and then aligns their access to the secondary and tertiary level care.