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Improved healthcare service delivery of a country is a cornerstone of economic growth and development. For this, governments all over the world have a compelling reason to provide good medical treatment and support to every citizen, regardless of their ability to pay. To fulfil this fundamental obligation which is essential for human happiness and well being of a nation, many are today resorting to equitable financing mechanisms prominent of which is the National Health Insurance Scheme (NHIS). The goal of the scheme is to make it easier for government to provide equitable access and financial coverage for basic health care services.
In developed countries, the United Kingdom for instance, National Health Service (NHS) is designed to provide medical treatment and support to everyone, not considering their ability to pay. But while it provides a valuable service, paying for private health insurance offers three key advantages; shorter waiting times, quicker diagnosis and better facilities.
The India Health Service (IHS) was established in 1955 to take over health care of American Indian and Alaska Natives from the Bureau of Indian Affairs (BIA) to the Public Health Service (PHS) in hopes of improving the healthcare of Native Americans living on uncertainties. This IHS provides a variety of health services in outpatient and inpatient settings, with benefits including pediatrics, physical rehabilitation, pharmacy, dental, behavioural health, immunizations and optometry. Though the benefits differ by locations but it all aim at bringing ease to the people.
Unlike UK and India where privileged Nigerians go to for medical tourism, Nigeria and other African countries fall far below in the allocation of resources to health care , and hence in striving to meet up with the developed world in the area of providing quality health care. A good percentage of the African populations are too disadvantaged to meet the expense of check-ups and medical treatment, and for many the transportation costs to treatment facilities are too illicit in the first place.
Undoubting, health insurance is dreadfully needed, but poverty has undermined efforts particularly in rural areas. Ghana is the first in Africa to successfully implement a social health insurance at a national level, getting rid of ‘cash and carry’ system of payment. Ghana shares a similar post-colonial history to Nigeria in terms of health care in the country. After independence in 1957, the Ghanaian government also introduced a tax-based health financing system in which services were provided free at the point of use by the public sector. By the early 1970s, however, the effects of a stagnating economy meant that the government could not sustain this mode of health financing and delivery.
Like Nigeria, the government introduced nominal user fees in the public sector, which in 1985 were raised significantly with the aim of recovering at least 15% of recurrent expenditure. This user fee system, known by the term ‘cash and carry,’ had negative consequences in access to health services, especially for the poorest in Ghanaian society. Limitations included long delays in accessing health services and incomplete prescription purchases.
In 2001, Ghanaian Government passed legislation which established its own NHIS in 2004, with the aim of achieving universal coverage for the population as a whole. Ghana’s public healthcare system allows three different kinds of Insurance plans (District Mutual Health Insurance Schemes, or DMHIS; private mutual insurance schemes; and private commercial insurance schemes).The most popular plan is the DMHIS, which operates in every district in Ghana and it worth emulating.
In Nigeria the federal government re-established an act under Act 35 of 1999 constitution to ensure access to good health care to all Nigerians at an affordable cost. The NHIS is to provide social health insurance in Nigeria where health care services of contributors are paid from the common pool of funds contributed by the participants of the Scheme.
It is a pre-payment plan where participants pay a fixed regular amount. These funds are pooled, allowing the Health Maintenance Organizations (HMOs) to pay for those needing medical attention. It is primarily a risk sharing arrangement which can improve resource mobilization and equity. It is indeed regarded as the most widely used form of health care financing worldwide.
However, since the inception of NHIS one can virtually count the number of beneficiaries, as it seems not to target the rural dwellers that are not tax payers and do not have access to the necessary facilities for registration. In some states, this scheme is only limited to government hospitals which are quite few.
The reality on ground, however, is that there is no way government will fund free healthcare the way it is supposed to be funded. The best option which is the practice in the developed world is contributory health scheme which is quite working in Ghana. In Lagos State, for instance, though a law was passed in 2015 which allow the government to do Health Insurance Scheme; the buying-in of citizens is still limited. For this, the government is on the verge of making it mandatory.
As a departure from what we have at the federal level, in the next few months, health insurance scheme will be mandatory targeting 24 million residents in the State. Not a few discerning minds will agree with Lagos State that any health insurance scheme that is not mandatory will never succeed in Nigeria. Ours is a developing country where people will naturally not want to pay for their health.
Basically the principle behind the scheme it is to mobilise funds from different sources so as to cover the poor too. This means they will no longer have to dig their hands into their pockets to pay for healthcare as the scheme stand on the believe that if resources of every other person in the state are pulled together, those that cannot afford will have a chance to access healthcare.
Lagos has a provision in the law which states that one per cent of the consolidated revenue will also go into the fund. What the government will make sure of is that the system is able to determine specifically how to measure the level of poverty, so that the poor will truly benefit from the scheme.
Surely, the scheme will impact on Lagosians in many ways. They will have better quality and access to healthcare services. This will reduce the cost of care while better service is offered. This scheme will reduce mortality and morbidity rate in Lagos, with emphasis on disease prevention, health promotion. Poor Lagosians will better be protected and better positioned to seek employment because they can take care of their health. Government funding will then take care of public health issues. The health insurance scheme is a game changer for the sector. And that’s one of the key building blocks of any health system.
Meanwhile, while government is doing its bit, the public should also play their role. The enlightenment has been ongoing for a time long enough for people to embrace this laudable scheme.
Blessing Vandefan
