On May 17, there will be a public hearing on a bill to repeal Nigeria’s Health Insurance Scheme Act. Here’s what is changing.

Nigeria’s lawmakers are few sessions away from signing a bill that will repeal the existing National Health Insurance Scheme Act, Cap. N42, LFN 2004, and replace it with the National Health Insurance Commission Act. The new bill which is being sponsored by the Chairman, Senate Committee on Health, Senator Olarewaju Tejuoso, has already passed second reading last week and its most popular provision is to make it compulsory for employers of labour with at least five workers to subscribe to the scheme.

Under the current NHIS Act, employers with 10 workers can voluntarily join the scheme, participation is not mandatory but the new law will change this as it will become mandatory for employers to join the scheme when it becomes law – particularly those with 5 employees.

Commenting on this repeal move, the sponsor of the bill, Tejuoso, told PUNCH that they are hoping to get the views of all stakeholders before the bill becomes law. 

“We are inviting people to bring their proposals on May 17 during the public hearing that will take place in Abuja; we have not yet amended the Act. That is why we are holding the public hearing so that everyone can come and contribute. Majority of people want it (participation by private employers) to be mandatory; some don’t want it to be; but after the public hearing, we will come to a conclusion.”

The new law wants to ensure a more effective implementation of a national health insurance policy that will enhance access to health care services to all Nigerians, as well as promote and effectively regulate health insurance schemes in the country.

The Section 1 of the bill affirms the establishment of the National Health Insurance Commission with the principal objective of ensuring the effective implementation of a national health insurance policy that enhances access to health care services to all Nigerians; promote and regulate health commencement; and establishes the National Health Insurance Commission health insurance schemes in Nigeria.

The bill affirmed that: “These types of health insurance schemes will be established and operated in the country: public sector social health insurance scheme to cover public sector employees and their dependants; organised private sector social health insurance scheme; mutual health insurance schemes; vulnerable group funds; and any other health insurance scheme as may be approved under the provisions of the bill.”

The law will berth the establishment of public sector social health insurance schemes (referred to as the public sector schemes) for the purpose of providing health insurance coverage, which will entitle persons working in the public sector and their dependants the benefits of prescribed good quality and cost-effective health services. It can be established by the Federal Government; a state government, including the Federal Capital Development Authority; or a local government to cover all its employees and their dependants.

It also makes provision for an organised private sector social health insurance scheme (referred to as organised private sector scheme) for the purpose of providing health insurance, which will entitle ensured persons and their dependants to the benefit of prescribed good quality and cost-effective health services as set out in the bill.

“The organised private sector scheme shall cover all employees of organisations in the private sector that employ at least five workers as well as to those individuals who may want to voluntarily join the scheme.”

For the private employer, the bill stipulates that an employer who has a minimum of five employees will together with the persons in his employment pay contributions of such rates and in such a manner as may be determined from time to time. This is how it is going to work. The  registered employer under the organised private sector scheme will deduct from his employees’ wages the approved amount of contribution payable by the employee.

This contribution, along with that of the employer, it adds, will be collected by or remitted to the organised private sector fund insurer for the purchase of a defined package of health care benefits for the enrolees.

Argument in favor of the new bill

The new bill is attempting to build on the shortcomings of the NHIS Act, particularly its inability to provide insurance coverage for over 93 per cent of Nigerians.

“The NHIS ensures the pooling of funds from different sectors of the economy, with many people contributing money but only a few of them actually falling ill. The essence is to guarantee free health care for the contributors whenever the need arises. While the importance of a virile health insurance scheme cannot be over emphasized, experts have faulted the fact that majority of those on the NHIS enjoy cover only for minor ailments,” PUNCH reported.

The way that NHIS was set up made it so that most of those enrolled in the scheme are public servants – many of whom are not even aware of how the system works talk less of using the scheme to access healthcare.

“I won’t lie to you, I don’t know how the NHIS works even though I have been automatically registered on the scheme. They make the deductions yet I still pay hospital bills from my pocket when I go to the hospital. From what you’ve explained to me, the new law will not address the communication gap on how the scheme works either – it will only make more money available to the scheme to spend on whatever they want,” said Mr Ayo Akinbambi, a public civil servant.

On the government’s side however, the emphasis on making it mandatory for the private sector also was brought about by the need to provide coverage for workers in privately owned firms but this is not widely seen as addressing the critical issue responsible for the unpopularity of health insurance among those it is meant to provide with access to health service.

“The word in the media is not helping either. It is just as if government is providing healthcare providers in the country with free money. Every doctor is opening private hospitals now so that they can claim that they are treating patients under the NHIS scheme. This is a very bad message being portrayed and letting the people know that they are not being scammed will go a long way in restoring the confidence of Nigerians in the scheme,” Akinbambi told HealthNewsNG.

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About Author

Paul is a university lecturer, medical researcher, extensively published author and freelance contributor. He holds a MSc degree in cell biology and genetics, and is a PhD candidate of the University of Ibadan.

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