EVALUATION OF THE EFFECT OF NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN ENHANCING QUALITY HEALTH CARE DELIVERY: GENERAL HOSPITAL WUSE, FCT AS A CASE STUDY
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Background Of The Study
The National Health Insurance Scheme (NHIS) was established with the objectives of achieving Universal Health Coverage (UHC) and ensuring access to good health care services to every Nigerian and protecting Nigerian families from financial hardship of huge medical bills; and for matters connected therewith. The rising cost of health care services and the inadequate fund availability for health facilities to meet the challenge of improved health care have consistently negated the ability of Nigerians to access quality health care services in Nigeria. The advent of NHIS is expected to ensure the overcome of these challenges. The quest for NHIS dates back to 1962 when the need for health insurance in the provision of health care to Nigerians was first recognized1. It was fully approved by the Federal Government in1997, signed into law in 1999 and launched officially on the 6th June 2005. This scheme has been designed to provide comprehensive healthcare delivery at affordable costs, covering employees of the formal sector, self-employed, as well as rural communities, the poor and the vulnerable groups2. The scheme is a form of managed care that pools regular financial contributions of members and pays a network of providers of healthcare for defined specific set of health care services, which in turn are accountable for cost containment and improving health outcomes3. Contributions to the scheme are made by employees, employers and in some cases the government. The system is identical for all enrollees and the premiums are based on income rather than health status, with collection systems for contributions organized with industrialized setting4. The vision of NHIS is to secure universal coverage and access to adequate and affordable health care in order to improve the health status of Nigerians5. The role of insurance in health financing is two folds: (i) to raise revenue for health care services, and (ii) pool these resources so that health risks can be effectively shared among the members of the insurance scheme6. The scheme’s main objective is therefore to achieve equitable access to health care in Nigeria as an alternative source of funding for a rapidly expanding and increasingly costly health care system.
The Nigerian government instituted this social health insurance system to bring solution and improvement to the health challenge of its citizens and apply insurance principles to cover cost of defined medical benefit packages. This insurance involves risk sharing between those who will need the benefits and those who will not. It also involves spreading the burden of cost of health care services to the insured over time so that the insured can access services any time without paying. The rationale for establishment of NHIS is therefore very robust at reducing the burden of financing healthcare service. Evidences from countries that have institutionalized national health insurance program indicate positive impact on the health care system7. In a study in Baltimore USA, health insurance was found to lead to an increase in non-urgent utilization of health facilities8. Similarly in Taiwan, the utilization of most prenatal and intrapartum care services increased after commencement of NHIS.
Also in Jordan, insurance was found to have a positive effect on the utilization of curative care and significantly increased the number of visits per illness episode2. Generally, insurance is found to increase the intensity of utilization and reduce out-of-pocket spending 6. However, in Nigeria, since the NHIS was established, not much has been carried out to investigate utilization and access to quality health care as a result of the introduction of the scheme 9.
Expanding access to health insurance is an important part of an overall strategy to achieve Universal Health Coverage (UHC), which implies an assured access to and use of high-quality health care services by all citizens and protection for all individuals from any catastrophic financial effect of health. Universal Health Care can be a major determinant of improved health outcome for all citizens especially the poorest people. Nigeria is eager to achieve UHC. Since the establishment of National Health Insurance Scheme (NHIS) in 1999, Nigeria has been in a hurry to effect major changes and an initiative to expand health insurance in the country. However as of mid-2012, NHIS still covered only about 3% of the population (about 5 million Nigerians) and these are mostly members of the formal sector, particularly federal civil servants 10. In 2016, statistics also showed that the scheme only covered less than 10 percent of Nigerian population despite the intention of the government to provide accessible and affordable health care services11. This implies that most of the vulnerable populations are left at the mercy of health care services which in most cases are not affordable. Despite this robust nature of NHIS, the health care demand is still very high. This bothers around the operations of NHIS and level of satisfaction of clients utilizing the NHIS services. Identified factors responsible for lack of satisfaction of NHIS services include shortage of drugs and out-of-stock syndrome, unavailability of blood and essential consumables, prolong waiting time which many refer to as waste of precious time, poor attitude of staff to work and unnecessary protocol.
NHIS had earlier been implemented to target the formal sector which amount to less than 20% of the total population of Nigeria. It is expected that NHIS will be at its peak in delivering effective and quality services due to its small target population. However, this has not been the experience of Nigerians enrolled under NHIS as many still prefer to visit hospitals where services received will be paid for out-of-pocket (OOP).
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