NHIA Moves Against Hospitals Denying Insured Patients Care

The National Health Insurance Authority (NHIA) has intensified efforts to protect health insurance enrollees from improper charges and denial of covered services, as the number of Nigerians with health insurance rises to 23.02 million.

The Director-General of NHIA, Dr Kelechi Ohiri, disclosed this at the quarterly media briefing of the National Primary Health Care Development Agency (NPHCDA), in Abuja.

Ohiri said the Authority had secured refunds for patients who were improperly charged, issued warnings to healthcare providers and delisted facilities where necessary following investigations into complaints.

He said the NHIA was strengthening oversight of healthcare providers and health maintenance organisations to ensure that Nigerians received the services covered by their insurance plans.

To improve transparency, Ohiri disclosed that the authority was introducing QR codes to enable enrollees to check the services covered by their insurance, while its 24-hour call centre would provide a channel for complaints and enquiries.

He said the measures were aimed at improving accountability within the health insurance system and building public confidence in the scheme.

According to him, the number of Nigerians covered by health insurance increased by 42 per cent, from approximately 16 million in January 2024 to 23.02 million.

Despite the growth, Ohiri said expanding coverage remained a challenge, particularly as high out-of-pocket healthcare expenditure continued to expose households to financial hardship.

He noted that the National Health Insurance Authority Act 2022 made health insurance mandatory for Nigerian residents, stressing the need for stronger enforcement and greater public understanding of the benefits.

Of the 23.02 million Nigerians covered, 3.18 million were poor and vulnerable people whose premiums were paid by the government through the Basic Health Care Provision Fund.

Ohiri said the Authority was also developing insurance arrangements for app-based workers, delivery personnel and self-employed Nigerians who lacked employers to pay their premiums.

He added that plans were underway to extend coverage to inmates in correctional facilities, following approval by the Ministerial Oversight Committee.

Implementation would involve assessing and accrediting healthcare facilities serving inmates, verifying eligible beneficiaries through their National Identification Numbers and assigning them to appropriate primary healthcare and referral facilities.

The NHIA is pursuing the expansion alongside broader efforts to strengthen healthcare delivery at the grassroots.

At the briefing, the Executive Director of NPHCDA, Dr Muyi Aina, said the federal government had revitalised 4,434 primary healthcare centres nationwide, with 3,526 fully renovated, commissioned and handed over to state and local governments.

Aina, however, urged state and local governments to ensure the facilities remained functional through adequate staffing, maintenance and operational funding.

He said the agency was working to increase the number of facilities participating in the Basic Health Care Provision Fund from 8,300 to 13,512.

The federal government has also approved an additional N40 billion through the fund to support healthcare delivery, essential supplies, health security and emergency medical transportation.