Commanded to be healthy – Lekan Sote
any organisation with expertise and capability to administer all or a portion of the insurance claims process, including administration of claims, collection of premiums, enrolment and other administrative activities, which is registered with the Authority.
To appreciate the importance of delivering cheap healthcare to Nigerians, you should consider the testimonial of the Chief Executive Officer of a Lagos highbrow private hospital, who boasts that his hospital prioritises “high quality, affordable (healthcare) services to Nigerians.” If you’d like to know, affordable is just another word for accessible.
The CEO then goes on to boast that (in spite of the white shoe profile of the hospital that is based in Ikeja GRA neighbourhood of Lagos State), “to register as a patient… (in the hospital is) ₦5000, and to have a consultation with a specialist family physician is also (just) ₦5000.”
The buzzword, “affordable,” is the hallmark of the Health Insurance Scheme that has now been transformed into a more structured arrangement and the introduction of an Authority that will compel conformity with its intentions.
You may not have heard that enrollment in the healthcare insurance scheme in Nigeria is no longer optional. It is now compulsory! This affordable healthcare insurance scheme is just one step removed from free healthcare for the citizens.
The voluntary National Health Insurance Scheme has now been put under the administration of a National Insurance Health Authority, which has powers to compel enrollment, as long as you are on Nigerian soil.
By the new laws of health insurance in Nigeria, you are going to be compelled to stay healthy. You can no longer choose to be sick or endure an ailment in Nigeria because the NHIA will insist on getting you to be well.
And that should have immense positive impact on the performance of labour in the Nigerian economy, which is already the biggest in Africa. Everyone knows that Nigeria has Africa’s highest Gross Domestic Product.
The Heath Insurance Authority Act will make it mandatory for all employers and employees in both the public and private sectors, with at least five employees, enterprises who play in the informal sector and, everyone resident in Nigeria, to enroll in the healthcare scheme.
The Authority is empowered to promote, regulate and integrate the health insurance scheme and harness private sector participation in the provision of healthcare service in Nigeria. With the Third Party Administration provision, not only Health Management Organisations are entitled to participate in private sector healthcare insurance, mutual health organisations are also allowed.
The NHIA specifically allows the participation of, “any organisation with expertise and capability to administer all or a portion of the insurance claims process, including administration of claims, collection of premiums, enrolment and other administrative activities, which is registered with the Authority.”
The Act however, removes fund management from the HMOS, and domiciles it in State Health Insurance Schemes. So, whereas the HMOS can still collect premiums from participants, they must remit the takings to the SHIS in the state where they operate. NHIS is, in turn, obligated to invest the funds received, but through the NHIA.
This, you will agree, should provide very close monitoring of the contributions and prevent abuse of participants. But as impressive as this requirement appears to be, experts are concerned that a bureaucratic agency is wedged somewhere within what should have been an entirely commercial and private sector driven process, though they don’t mind if a private sector driven process will be monitored and regulated by the state.
It’s a bit odd that the NHIA is at one and the same time a regulator of the Health Insurance Scheme nationwide, as well as a participant, an insurer-somewhat like a reinsurer-of health insurance companies and investor of what the Act describes as funds not immediately in use.
That is a lot of discretion in the hands of a bureaucratic agency that will be run by state-appointed operatives that may not be exactly accountable to the contributors of the funds. There is no provision for public annual rendering of accounts of how the funds are invested or used. There is still a lot of grey in the whole process.
But there is something very good part to the Act: The Vulnerable Groups Fund, which will provide subsidy for health insurance coverage for vulnerable persons and for the payment of health insurance premiums of indigent people.
So, everyone within the territory of Nigeria will be covered by the new health insurance scheme, whether they can pay the premium or not. Like free education, that is not exactly free at all levels in Nigeria yet, this is a major social investment plan that raises the egalitarian credentials of the Nigerian state.
Lagos State Government appears to be responding to the vulnerable groups health insurance coverage in a rather creative manner. It is tying its Clean Lagos air pollution strategy and campaign to the health insurance scheme.
Dr. Dolapo Fasawe, a public health practitioner, who works with Lagos State Environmental Protection Agency, notes that a significant number of the people of Lagos State die of environmental pollution every year.
To enroll members of the Lagos State public in the State Health Insurance Scheme, Lagos State Government extends health insurance cover to anyone who can pick 20 bags-probably Ghana-Must-Go bags– of used plastics from off the streets.
This scheme also frees the Lagos drainage and helps to fight flooding that disrupt lives and destroy properties. As much as the current flooding of Nigeria is attributed to the release of water from Cameroon’s Lagdo Dam, clogged drainages also significantly contribute to the menace.
Of the 200 million, or a little more, Nigerians, only about three per cent, or six million, have any form of health insurance plan. The flipside is that 97 per cent of Nigeria’s population are out of the health insurance loop. Of the 6 million covered, 56.7 per cent, or more than half, are men. It goes without saying that 43.3 per cent are women.
A major Nigerian insurance company attributes low insurance rate in Nigeria-0.5 per cent-to inadequate access to relevant information platforms, weak regulatory framework, lack of skilled personnel, poor knowledge of available insurance services and low standard of living in Nigeria.
This insurance company, that may not be too excited if its name were revealed here, explains that the major challenges facing the insurance industry in Nigeria include: Inappropriate pricing and risk profiling, poor product definition and fit, inadequate distribution channels and low public confidence in actors in the Nigerian insurance industry generally.
Affordable healthcare, that some may argue is a socialist agenda, has found a place even in America that has the most capitalist, some may say ultra conservative, ideology in the world. Americans too agree that the state must intervene on behalf of the weak within the society.
America’s Affordable Care Act, informally known as Obamacare, is the most recent and fundamental review was introduced by America’s 44th President, Barack Hussein Obama. But it’s an open secret that denizens of the ultraconservative Republican Party, custodians of America’s capitalist ideology, are doing everything to pull it down.
Obamacare is a significant regulatory overhaul and expansion of America’s healthcare delivery system. It is most important provision is that no American citizen can be denied healthcare insurance because of pre-existing medical conditions that started before his healthcare insurance became effective.
And like Nigeria’s Health Insurance Act of 2022, which requires the provision of health insurance coverage for vulnerable groups, Obamacare requires state governments in America to ensure that healthcare insurance covers children who do not have families.
You’ll be shocked to know how many young American individuals have no families to call their own. After the father simply absconds, or never even showed up in the first place, and the mother is heavily addicted to drugs, too many American youths are usually left to fend for themselves.
In the 1970s and 1980s if you went to Chapin and 7th Streets in Washington, DC, Waco, in Texas, Roxbury in Boston, Massachusetts, Harlem in New York City, you will see the telltale signs of people that you may describe as derelict. Most of them are poor, abandoned and sick, in the main part.
So that no one will in doubt of what to expect from the Obamacare scheme, the law took time to define what it means by the Essential Healthcare Benefits that a health insurance policy holder is entitled, or expected, to get.
America’s National Academy of Medicine defines essential health insurance benefits as: “Ambulatory patient services; hospitalisation; maternity and newborn care; mental health and substance use disorder services, including behaviourial health treatment; prescription drugs.”
Others are: “Rehabilitative and habitation services and devices; laboratory services and chronic disease management; and pediatric services, including oral and vision and others.” Though this is not be exhaustive, it is at least as clear and definitive as possible.
Under Nigeria’s new health insurance regime, only age and location, market demographics, can be used to determine the premium that a prospective contributor can pay. An insurer cannot factor in pre-existing health conditions to determine the premium that a policyholder will pay.
And just as insurers are not going to be allowed to dump policyholders who are sick, insurers will be monitored so that they must spend at least 80 to 85 per cent of premiums they are paid on health costs, while the policy documents must provide a medical expenses Maximum-Out-Of-Pocket cap that you can expect both individuals and families can be expected to pay.
This new private sector driven health insurance plan, Nigeria may be travelling the (albeit indirect) high road to achieving the sentiments of the 2001 Abuja Declaration which requires African States to devote at least 15 per cent of their annual budgets to healthcare delivery.
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