For the umpteenth time, out-of-pocket payment for medicare constitutes over 90 percent of private spending of Nigerians. With less than 10 million Nigerians covered by health insurance in both public and private sector, this development has left majority of Nigeria’s 160 million people without insurance cover.
With the prospects of achieving universal health coverage (UHC) in Nigeria receiving a major boost in March 2014 following the Presidential Summit on Universal Healthcare held in Abuja and subsequent summit declarations, achieving UHC is bedevilled by a plethora of factors.
Low awareness levels resulting in poor penetration of health insurance, uneven quality of healthcare services, poorly coordinated and inadequately staffed hospital systems, high incidence of medical tourism and a history of distrust among key stakeholder groups within the health sector has hindered collaboration and cohesiveness, thereby limiting the ability of the sector to push forward the UHC agenda.
Following push by Femi Thomas, executive secretary, National Health Insurance Scheme (NHIS), that about 24 million primary school pupils ages 12 years and under are scheduled to be covered under the rejuvenated scheme, calls for the restructuring of Nigeria’s health insurance with NHIS providing technical and manpower assistance to states to set up their health insurance will deepen UHC.
Speaking with BusinessDay, Lekan Ewenla, managing director/chief executive officer, Ultimate HMO, said that instead of the NHIS setting up offices across the 36 states of the Federation, thereby increasing recurrent expenditure, each state should be urged to have health insurance scheme for their citizens with NHIS providing technical manpower and support to run the system effectively.
Citing the example of National Primary Health Care Development Agency (NPHCDA), a parastatal of Federal Ministry of Health, whose mandate is to develop national primary healthcare (PHC) policy and support states and LGAs to implement them, Ewenla said that each state should conduct its market research in a bid to evaluate the insurance premium that is payable by all, disease pattern, etc.
As is the case where NPHCDA support state government in their immunisation programme, Ewenla said, states across the country will have to drive the health insurance initiative with funding support from the Agency as a buffer to support the insurance premium that is paid by beneficiaries.
Commenting on Ultimate HMO’s progress in Nigeria’s health insurance space, Ewenla maintained that the philosophy of the company is to develop customised healthcare packages that would address the needs of a targeted segment of the society.
With share capital of over N400million and 30,000 enrolees in the 36 states, including the Federal Capital Territory, Ewenla revealed that the firm is focused on ensuring Nigerians have access to healthcare services through collaboration with relevant stakeholders and providing massive scale-up of health insurance to Nigerians in line with National Health Insurance Scheme (NHIIS) 30 percent UHC target for 2015.
“We have designed products to capture various segments of the informal sector. U-health Educare is a health plan designed for pupils/students from kindergarten level to tertiary level. U-health Medi-Guard is designed for guards of private security organisations while U-health Local Tavel is to provide evacuation and stabilisation services for road travellers while on transit. Also, U-health Safety Plus is designed for employees in the construction industry.
“We will continue to play a major role in ensuring equitable distribution of healthcare facilities through identifying and encouraging newly established and/or old healthcare facilities on the benefits of having their facility accredited by the NHIS,” Ewenla added.
The health insurance business has witnessed a boom in the country for over a decade (from 13 in 2000 to 66 HMOs in 2012), becoming more sophisticated with monthly capitation fees processed manually by HMOs put at over N5 billion among over 6,000 accredited providers.
