Henceforth, in Lagos state, health insurance will be mandatory, so says the Health Commissioner of Lagos state, Jide Idris, who explained that the State Government’s resolve to have its own scheme is underscored by the fact that the health financing policy was a major point of discussion at the last two State Councils on Health meeting in 2013 and 2015.
The Lagos state health insurance scheme concept represents a collaboration between the State Government, the Local Government and the Private Provider with the latter providing an element of Public-Private-Partnership. The Ministry of Health being the initiator of the scheme subsidizes the capital being paid to the provider, perform oversight functions and provides technical support.
The Scheme is targeted predominantly at the informal sector workers, and offers a package of prepaid healthcare services for enrolled members of the community. The projected outcome of the intervention is the conversion of the current prevalent out-of-pocket payments for healthcare into prepayments which is more progressive and equitable.
For the Commissioner, The State Council on Health is the highest policy advisory body on health in Lagos State and it provides a veritable forum for dialogue between a broad spectrum of decision makers, policy implementers and key stakeholders from all spheres of the Lagos Health Sector.
Speaking exclusively to BusinessDay, the commissioner says “The need for it is essential because the challenges in the health sector are numerous. To provide service to people, the key things you need to address is the issue of access and access has many dimensions.
“There is physical access, financial or cultural access. When you talk about quality of care, no matter how equipped a hospital is, if people don’t come, it is not a success story hence the need to insist everyone in Lagos must be under an insurance scheme. We need to address the issue of effectiveness; you must provide a quality care that is effective,” he said.
Though the law was passed in 2015, it however stipulates that a minimum of 1 percent of the revenue generated by the state ought to go to the scheme as equity fund.
Idris insists that henceforth, it shall be mandatory to be under a health insurance scheme and the reason for waiting till now to enforce it is because, setting up an insurance scheme requires a lot of planning as you need to create the institutions to ensure the success of the program.
“Some have said we are very ambitious but we had to do many studies, business process manual, and implementation plan and so on. These take time to implement. Anyone who requires more service can purchase a higher plan. The basic one is compulsory, you have no choice, you must be in one form of health insurance or the other that is what the law says.
“The basic one is N40, 000 for a family of 6. It was N60, 000 but the state government after consultations decided to bring it down to 40,000 per year so even the grassroots can participate. There are also insurance plans for singles or even those with families not up to 6. If you haven’t registered, you will be paying through your nose because there is nothing like free health again.
“What you are charged once you are under the plan is way better than what you would be charged if you aren’t. As an enrolee, you can only access the system through your Primary Health Care provider and you have a choice to choose between the private or public provider,” Idris explained.
For the National President of Healthcare Providers Association (HCPAN), Umar Oluwole Sanda, speaking exclusively to BusinessDay, it is the best way to go because within a few years, Nigeria will be better since the aim after all said and done is to achieve universal health coverage.
In his words, “There is the larger informal sector still waiting to be tapped into. Before, we believed only 4 percent of the informal sector is covered but now, we are told it is 1.2 percent. So many figures but whatever it is, it is less that 4 percent, how about the remaining 96 percent? Nigeria is a large country, population of 180 million, see why all other states should key in and follow as Lagos?”
However, Sanda believes to make this more effective and encouraging for the providers, remuneration is advised. According to him, the N40,000 stipulated by the state government needs to be reviewed because price of healthcare items are skyrocketing. In his words, “We will continue to improve quality and quantity but because quality is money, it is not cheap, and as a provider, I will want to say that just as quality is not cheap, we will expect something higher for providers as remuneration not just a pity fare and we are ready to serve.”
Lending his view on the mandatory health insurance in Lagos going forward, Olumide Okunola, Senior Health Specialist, Health In Africa Initiative, Nigeria Program, World bank, believes it is a welcome idea as he identifies high poverty rates and lack of mandatory health insurance as major challenges with the healthcare system in Nigeria.
He revealed that a survey conducted for private healthcare providers about what they think are major hindrances to the profitable operation of a medical or pharmacy business in Nigeria showed that 77 percent of them said inability to pay was responsible and 65 percent attributed it to lack of access to financing.
“Therefore this initiative by Lagos state is truly laudable, we are glad to see the efforts and we encourage other states to follow same path”
On sustainability of the scheme, Idris says “We are creating a pool of funds. People will contribute, the government will contribute and we will ensure the money is managed properly for the purpose it was received.
“In Rwanda, they have achieved more that 85 percent coverage in less than 6 years, if it can work there, why can’t it work here? Same in Ghana, they had a hitch but they have recovered and they have covered over 50-60 percent so why will our own be different?
“Payment collection may be a problem is the reason we have established various collection platforms. Pay your part and the money from government and private individuals will also assist,” Idris stated.
Kemi Ajumobi
