The Federal Government is reviewing the capitation fees paid to healthcare providers under the National Health Insurance Scheme (NHIS).
Capitation fees are the payments or grants to a doctor or school, among others, determined by the number of patients, pupils, or customers that are served.
This move addresses longstanding concerns from hospital proprietors involved in the scheme.
A statement by the NHIS said the Director General of the National Health Insurance Authority (NHIA), Dr. Kelechi Ohiri, announced that the capitation fees have not been reviewed for many years.
Ohiri noted that addressing the issue has become crucial for the healthcare sector.
It’s been a while since tariffs were reviewed. We initiated actuarial reviews in February to have a solid foundation for adjusting these tariffs,” he said.
The goal of the reviews is to gather evidence and determine an affordable basic minimum package of services for patients to ensure consistent and predictable healthcare services at hospitals.
Ohiri said significant support was being being provided to vulnerable groups to encourage their participation in the health insurance programme. The initiative is a key priority for the Federal Government, the NHIA boss said.
The Vulnerable Group Fund acknowledges that while health insurance can be contributory, it can also be non-contributory, where the government pays for the poor and vulnerable,” he said.
The fund, which is a part of the NHIA’s mandate, supports poor Nigerians, people with disabilities, internally displaced persons (IDPs), the elderly, and other vulnerable groups.
The definition of vulnerability now includes women at risk of death during childbirth, a group predominantly found in rural areas.
According to him, the NHIA is enhancing partnerships with state government-run health insurance programmes, which are crucial for boosting national enrolment.
Ohiri praised state governments for their efforts at expanding health insurance.
Every state in Nigeria now has a state health insurance scheme, with Rivers State being the latest to join. Many states are also setting up Equity Funds to complement federal efforts,” he said.
Despite the efforts, the NHIA boss said only about 16 million Nigerians or seven per cent of the population, are currently covered by health insurance, with the new NHIA Act aiming to increase the coverage.
“With the Act making insurance mandatory, we now have a pathway to universal coverage. We aim to increase the coverage significantly from the current seven per cent,” Ohiri said.
The NHIA boss stressed that improving health insurance coverage is a collective responsibility involving both public and private sectors.
“We have a mixed insurance space with NHIA, state health insurance schemes, private health insurance agencies, HMOs, and administrators.
“Achieving universal healthcare coverage requires joint efforts – from the federal and state governments, private sector, and civil society organisations (CSOs),” he added.
