In 2012, the United Nations adopted a blueprint for peace and prosperity for people and the planet, now and into the future. This blueprint was called the Sustainable Development Goals (SDGs). There are 17 SGDs established on a framework of previous declarations, development plans and global agreements including the Agenda 21 of the Earth Summit 1992, Millenium Development Goals (MDGs) in 2000, and many others.
SDG-3 above (Good health and wellbeing) is aimed at ensuring healthy lives and promoting well-being for all, at all ages. It x-rayed the core factors affecting the poor distribution of health care services to people across all geopolitical zones of the world and ages.
One of those factors affecting the distribution of health care services is poverty (SDG-1) and monetary power to pay for health services when needed. It was collected that out-of-pocket payment for health services which is practised in many countries of the world is contributory to the problem of inequitable and inefficient distribution of health care services. Thus, the introduction of the health insurance scheme.
The Annual General Meeting & Scientific Conference (AGM/SC), ARD, UBTH, 2019
At the title of this article, you saw “AGM Review: Problems Undermining Health Insurance In Nigeria”. Didn’t you? That’s what you should see just in case you didn’t pay close attention to that.
Most of the points in this article are excerpts from the Annual General Meeting (AGM) and Scientific Conference for the Association of Resident Doctors in the University of Benin Teaching Hospital (UBTH), 2019. I was opportune to attend the conference and I took down a few points as you will see here.
Excerpts From the Keynote Speech by Prof. Dominic Osaghae
Prof. Dominic Osaghae (Consultant Paediatrician and Dean, School of Medicine, 2019) at the Igbinedion University, Okada, Benin City, Nigeria. He is a man of many achievements and there he was to talk about something that affects every one of us as individuals – Health Insurance.
He keenly emphasized the importance of health insurance as specified in the statement of the SDG-3. Here are some additional things he talked about;
Aims of Health Insurance
Insurance services generally aim to emancipate or reduce the effects of accidents, hazards, and natural and artificial disasters on the pockets of individuals, he stated. More specifically for the health sector, the keynote speaker gave two targets of SDG 3 that health insurance aims to achieve as follows:
- Universal Health Coverage
To achieve Universal Health Coverage (UHC) by means of financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
- Social Protection
To achieve social protection by way of prevention of out-of-pocket payment for health services in magnitudes that drastically affect the financial status of the individual. High out-of-pocket payments discourage hospital visits and in turn militate against the UHC goal.
Health insurance addresses these two targets above for the purposes of financial risk protection and enhancing access to quality essential health care by everyone. Another facet of universal health coverage will face issues surrounding provision of health care facilities, adequate manpower training and establishment of a functionally and structurally efficient health sector.
However, all things put in place, health financing will continue to be a problem at the patient’s level which can affect health-seeking behaviour and recourse to alternative, yet ineffective medicine.
Many nations of the world now have well-established insurance systems with significant number of registrants within the citizenry. However, Nigeria and some other developing countries of the world still have a very minimal insurance coverage within the population despite availability of surplus health insurance companies within the country. Thus, the problem of health insurance is only half-way solved.
Worsening Poverty Indices – as a Consequence of Health Insurance problems In Nigeria
Statistically, the keynote speaker stated that about 100 million people are pushed into extreme poverty following expenditure on health services; and another 800 million individuals and families spend over 10% of their household budgeting on health services only. This proportion of the household income would amount to values that are too big for the family to bear without drifting into a state of worsened financial status.
His recommendation to the National Ministry of Health was consolidation of the ministry’s efforts at selecting priority diseases for the local population, removing obstacles to efficient health care delivery thereby enhancing universal health care coverage for all categories of people in the country.
NHIS Call To Rescue Health Insurance In Nigeria
In 2004, the National Health Insurance Scheme(NHIS) was established under Act 35 of the 1999 Constitution of the Federal Republic of Nigeria with the following aims;
- Ensure that every Nigerian has access to good health care services
- Protect families from financial hardship caused by huge medical bills
- Limit the rise in cost of health care services
- Ensure equitable distribution of health care costs among different income groups
This health insurance scheme was created in line with SDG-3 to ensure availability of insurance services to all people at affordable rates. It focuses on bringing the knowledge of insurance services adn related services to the points where patients can access them. NHIS also established a system of registration for health insurance at the professional level.
For example, health workers can get registered directly from their payroll after they might have granted an informed consent to do so. Other possible routes of enhancing participation include targeting informal or semi-formal occupational sectors, guilds, associations, as well as promoting participation among caregivers of vulnerable group individuals.
Problems Undermining Health Insurance In Nigeria
There are more than 54 insurance companies in Nigeria with a most of them offering health-related insurance. However, insurance in Nigeria has welcomed very little participation amongst Nigerians and residents of the country. What could be the reasons for the low insurance coverage?
These problems may include the following;
- High premiums
- Poor accessibility to health facilities
- Limited hospitals with insurance coverage
- Limited coverage of insurance
- The mindset of natural protection
In the following section, we will discuss these problems undermining health insurance in Nigeria and how they do so.
1. High Premiums
A health insurance premium is an upfront payment made on behalf of an individual or family in order to keep their health insurance policy active and be able to cover for health care expenses, usually paid monthly irrespective of usage or not of health care services for the month.
High premiums may be a problem that could undermine people’s participation in health insurance. In Nigeria, however, health insurance premiums are not extremely large amounts but the low per-capita income of the average Nigerian makes them relatively high amounts.
If a person is not ill, that does not prevent the individual from paying the monthly premiums. This may seem like a waste of resources if this continues for so long, and might signal a need to discontinue the health insurance plan. However, this is not good enough reason if there is the proper understanding about the workings of health insurance – you pay for someone else’s bills today. Tomorrow, everybody pays yours.
2. Poor Accessibility To Health Facilities
Why pay for health insurance when there are the health facilities are yet inaccessible? As matter, this may ultimately affect patients visit to the hospital as they may resort to alternate medicine/tradomedicine.
Whether patient’s health insurance plan is active or not, poor health care service delivery will discourage them from seeking health care when they have some health problems. In this case, they will prefer to visit centres that provide better care with higher costs even when their health insurance supported by their primary centre is still active. Of course, that might be the end of their participation in health insurance.
3. Limited Hospitals With Insurance Coverage
Universality of health insurance is compromised of two things. The first, I scratched a little in the previous point above – significant number of hospitals with insurance coverage. Not all hospitals are registered with third-party insurance companies per time. If patients have active insurance plans, they will have to locate health institutions that accept their insurance request cards as the case may be.
In cases where health facilities that can accept their insurance plans are far away, this can further affect access to health care services by subscribing patients. Thus, insurance is unable to solve the problem for which it was created al-binitio and subsequently affecting users’ participation in insurance services.
4. Limited Coverage of Insurance
The NHIS remains the most affordable insurance service in Nigeria but some of its policies may be too strict. For example, NHIS limits number of individuals covered in a family plan to parents with four children. Any number other than that is not accounted for my this insurance scheme.
Also, quota is also placed on the number of days on admission that the insurance scheme can cover, as well as the type of medical and laboratory investigations supported. When these limits are reached, the individual is forced to continue treatment by paying out-of-pocket.
5. The Mindset of Natural Protection
Nigerians generally believe that nature protects them from illness or death and they can afford to make poor health choices and sacrifice proper hygienic practices on the alter of natural protection. As a consequence of this, they are not willing to anticipate or plan for any health challenges that may come their way.
At best, they would visit over-the-counter medicine stores when their aiment persists beyond what nature could handle. Why pay for insurance when they think they have a “strong body system” that illness cannot weaken?
Health facilities are poorly functional in the country and doctor-patient ratio is alarmingly poor but early visit to a health facility is among the topmost reasons for poor health outcomes in the country. As it relates to insurance, the mindset of natural protection could potentially hamper patronage of insurance as well as health services. I hope that when other things like good facility equipment, better access to health facility, etc, have been solved, this problem will naturally follow suit.
For SDG-3 not be defeated and UHC not nullified in Nigeria, insurance participation should be deliberately scaled up through the provision of solutions to the problems highlighted in this article.
Through the provision of efficient insurance services, many countries have achieved a more universal and efficient health care service delivery to their populace. Nigeria should make efforts to join the list of those countries who have achieved these successes and she can truly achieve that.
The keynote speaker at the AGM of the ARD, UBTH, Nigeria, also urged the Ministry of Health to choose priority diseases for the local population to strategically focus on preventing and treating them in areas where they are endemic. This is to prevent unwarranted need for admission, and consequent increased financial burden on the populace.