Abuja: The health insurance policy in Nigeria is designed to reduce out-of-pocket health expenses and promote Universal Health Coverage (UHC). The National Health Insurance Act (NHIA) of 2022, signed into law on May 19, 2021, replaced the 1999 National Health Insurance Scheme Act. Its primary aim is to regulate and integrate health insurance schemes, ensuring that every Nigerian has mandatory health coverage while catering to vulnerable groups. However, many enrollees are expressing dissatisfaction with the current state of the scheme. They claim that the quality of services has declined, and some benefits have been reduced or are no longer available.
According to News Agency of Nigeria, Mrs. Ese Williams, a civil servant, who has been using the scheme for 15 years, shared her concerns regarding the scheme’s effectiveness. She noted that previously enrollees only paid 10 per cent of the hospital bill after treatment, but she was recently asked to pay 40 per cent without stakeholder consultation. Williams also mentioned a decrease in the quality of drugs provided by hospitals under the scheme and urged the government to revisit the reforms to make the scheme more affordable and comprehensive.
Mrs. Bella Andrew, another enrollee, expressed her surprise that the scheme does not cover basic treatments, such as toothaches. She recounted experiences of being prescribed medications to be obtained from external pharmacies, which undermined the purpose of the insurance. Andrew questioned the value of her enrollment in NHIA, emphasizing the need for free treatment for common illnesses like malaria.
Mr. Ernest Okon, also a civil servant, argued for the flexibility to choose premiums, similar to private sector workers, to receive better services. He pointed out that public servants have limited access to services because their premiums only cover a small fraction of treatments. Okon suggested that hospitals should clearly display what services are covered by the scheme to avoid confusion.
Another enrollee, Mr. Emmanuel Afonne, shared a troubling experience regarding his family’s healthcare. He explained how his family was diagnosed with malaria and typhoid, but the hospital directed them to purchase medications elsewhere due to Health Management Organisations (HMOs) owing money, which delayed treatment. Although he was eventually reimbursed after reporting the issue, Afonne’s experience reflects the perceived decline in the scheme’s effectiveness.
In July 2024, the NHIA announced a 60 per cent increase in capitation rates and a 40 per cent rise in Fee-For-Service (FFS) fees. Dr. Kelechi Ohiri, the Director-General of NHIA, explained that the price hikes were due to rising healthcare delivery costs. He acknowledged that these increases might burden patients and employers who contribute to the health insurance scheme.
On February 3, 2025, Ohiri announced even larger increases in capitation and FFS payments, with capitation rising by 93 per cent and FFS payments increasing by 378 per cent, compared to rates from December 2023. These revised rates, approved by the Minister of Health and Social Welfare, Prof. Muhammad Pate, will take effect in April 2025. Ohiri stated that the goal of the adjustments is to improve healthcare quality, incentivise better services, and maintain financial sustainability.
Dr. Aminu Magashi, Coordinator of the Africa Health Budget Network (AHBN), commented on the NHIA’s decision, indicating a significant shift in the cost structure of health insurance in Nigeria. While the adjustments aim to improve services, Magashi cautioned that the challenge lies in balancing affordability with quality care. He suggested that the NHIA must monitor the effects of the changes and adjust them, if necessary, to maintain a robust healthcare system for all Nigerians.