Still On Health Insurance Coverage

Recently, the Nigerian Senate called on the federal government to expand the National Health Insurance Scheme  coverage to include patients with chronic kidney diseases.

According to them, the ailment constitute about 40 per cent of referrals to tertiary hospitals in Nigeria and was a significant contributor to daily hospital admissions.

In making this appeal, the lawmakers drew attention to the cost of dialysis sessions in Nigeria which range from N20,000 to N50,000 per session, whereas kidney transplant, an alternative to dialysis, is financially unattainable for many, with the cost running into several millions not adding the challenge of getting a donor with its own cost implication.

In our opinion, it is worrisome that the National Health Insurance in Nigeria provides limited coverage for chronic kidney disease patients, highlighting the need for expanded insurance coverage to support treatment.

It is from that prospective that we consider the call by the Senate as not only timely but commendable in view of the high incidences of non communicable diseases (NCD) and the attendant  mortality rate which is high indeed.

It will be stating the obvious to note that most Nigerians cannot afford the cost intensive treatment required for these non communicable diseases. In the circumstance, many sufferers have had to resort to crow funding to sponsor treatment for their ailments in this 21st century where world governments are declaring universal coverage for health.

A 2018 Nigeria Demographic and Health Survey indicated that about 97 per cent of Nigerians lack any form of health insurance and majority (70 percent) of Nigerians make out-of-pocket payments for health.

Universal health coverage (UHC), embedded within the United Nations Sustainable Development Goals (SDGs) is defined by the World Health Organization (WHO) as all individuals having access to required health services of sufficient quality without suffering financial hardship.

Sadly, in our view, effective strategies for financing healthcare, which are critical to achieving this goal, remain a challenge in Sub-Saharan Africa (SSA), especially in its most populous nation, Nigeria.

It is unarguable, in our opinion, that access to quality healthcare services without individuals suffering financial hardship remains a challenge in the country.

As a result, large percentage of individuals’ access to essential health services depends on direct out-of-pocket payments (OOPs), pushing millions of people further into the poverty bracket each year.

One of the consequences of this development  is that millions of people do not seek quality treatment for their health issues, exacerbating the problem and increasing the burden of preventable deaths in Nigeria.

Like every other law in Nigeria guiding establishment of  MDAs, we are of the view that the law guiding the activities of the health care providers needs to be reviewed to tally with modern international standard.

The federal government signed into law the new National Health Insurance Act (NHIA) 2022 on 19 May 2022, which replaces the National Health Insurance Scheme Act of 1999, which failed to enroll more than 10 per cent of the population.

The NHIA seeks to promote, regulate and integrate health insurance schemes and aims to secure mandatory health insurance for every Nigerian and legal resident, and establishes a fund for the vulnerable groups, which will provide ‘subsidy’ for health insurance coverage for vulnerable persons and payment of health insurance premiums for indigents.

For years, successive governments  have spoken of the need for nationwide health coverage as a public service, but the advance towards that goal has been slow and stunted.

While the private Health Maintenance Organisations (HMOs) tend to have more comprehensive service coverage, the NHIS mainly caters to priority diseases and limited diagnostic tests, excluding surgery.

Besides the discrimination that goes on in some facilities, a hospital is more likely to trust that a private HMO would be more responsive in paying for the services that their enrollees have accessed rather than the NHIS considering the bureaucracy they have to go through there.

As a newspaper, we are not ignorant of the cost intensive nature of some of these diseases and it shouldn’t be out of place to review and adjust the capitation upward to reflect the times in order to provide comprehensive coverage of illnesses.

In our view, poor public funding of the health sector, population increase that outpaces economic growth and fiscal crisis have combined to guarantee poor health indicators and out-of-pocket health expenditure of 70.52 percent, being the highest in sub-Saharan Africa.

In addition, the Basic Health Care Provision Fund needs better utilisation and transparency even as we dedicate more funds for service delivery to benefit the poorest of the poor.

In the meantime, we urge the federal government and other stakeholders to launch extensive public education campaigns to raise awareness about kidney disease prevention, risks, and available treatments and other non communicable diseases as well.