The National Health Insurance Scheme Functions

The health insurance scheme of any country is a legally implemented programme for health insurance that provides insurance services to its citizens against the expenses of health. The scheme may be dispensed by the private or public sector or both of them. The way the programme is funded varies from one country to another. The people who join the insurance scheme are mostly those who pay contributions for it. Furthermore, the contribution made per person varies depending on which insurance fund they belong to.

The way the health insurance scheme works differs from country to country. The provision of services might be conducted through private-owned or public-owned health care providers. Collection of money from members and the way services are provided differs from country-to-country. Some of the usual functions that these schemes perform for their countries are as follows:

• To ensure that there is equity in health care services being covered
• To manage the national health insurance fund
• To enforce, operate and manage the national health insurance scheme
• To register members of the national health insurance scheme
• To ensure that the poor can access health care services country wide.
• To register and supervise private national health insurance scheme providers
• To safeguard the poor and vulnerable against any form of financial risk
• To come up with proposals to the minister for the formulation of policies in the health insurance sector.
• To decide in conjunction with the minister the contributions that should be made by members of the national health insurance scheme.
• To come up with guidelines, processes, manuals for good execution and management of the national health insurance scheme.
• Provide identity cards to members of the national health insurance scheme.
• To tackle public education regarding health insurance or with the help of other bodies by monitoring and ensuring that there is compliance with the act, regulations, policies, guidelines, processes and manuals that are made under that countries act.
• To ensure that there is efficiency and highly regarded services under the national and private health insurance schemes.
• To give credentials to health care facilities and providers that offer health care services to members of the national health insurance scheme.
• To allow a decentralized system that can receive and resolve complaints by members of the national health insurance scheme and the health care providers.
• To discover and enroll people exempt from payment of contribution to the national health insurance into the national health insurance scheme.

These services vary a slightly for different countries depending on the government legislation on its national health insurance scheme. Though most of the schemes share similar objectives and that is to attain national health insurance coverage and affordable medical care. In terms of contribution or making payments to the scheme, some countries fund the scheme through tax payers’ money while others fund it through payments deducted from either employee or employers and sometimes from both.

3 Comments. Leave new

Muhammad kabir
October 15, 2017 10:02 am

We thank all those that contributed for this health insurance scheme

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May God help all thé faithfull members of this organisation to get to their ripe old âge.

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Dr Anok A Anok
March 3, 2018 3:52 am

Many years after its inception, a vast majority of Nigerians have no access to health care via this scheme. Even me, as a doctor, I don’t. The people in my village know nothing of it. Even the very rich are not making use of it, that is why they choose to go abroad for any kind of illness. Who is really benefiting from this scheme.? The healthcare providers complain of non payment of capitalism and for the services rendered. Was it only meant to further enrich the rich, the HMOs owners? I enjoyed an efficient and effective version of health insurance in Namibia. Our own is too stressful and expensive and serving the interest of an insignificant few only. Health for all Nigerians is still a mirage. Namibia, a far poorer country achieved health for all Namibians in 2000 according to WHO agenda. In 2018 Nigeria has not started. Why are we so negatively different. If you need me to join you to work out a better workable version of health insurance scheme for Nigerians reach me.

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