National Health Insurance Scheme in Nigeria: The Beneficiaries' Perspective

Introduction:

The world is pushing towards universal coverage for health care. National Health insurance scheme(NHIS) has been identified as one of the key strategies that would help achieve this. In 2005 NHIS was launched in Nigeria to provide equitable, good quality and cost effective health services for insured persons. However since inception there has been no evaluation of the scheme to assess beneficiaries’experiences with the scheme and indeed what benefits accrue to users.

Objective:

To document the experiences of insured persons with the NHIS in Nigeria.

Methods:

This was a cross sectional exploratory study carried out in Enugu, South-east Nigeria using pre tested interviewer administered questionnaire to elicit information on coverage, level of satisfaction and expenditures for health services including payment of premium under the NHIS scheme from 1200 beneficiaries.

Results:
28.7% of respondents do not have their health needs covered by NHIS whereas 29.5% said they were fully covered. 33.0% of the respondents were not satisfied with the scheme while 20.0% and 14.8% were satisfied and very satisfied respectively. 67.0% paid premium, 20.7% did not pay while 10.0% did not know if they paid or not. For outpatient, inpatient and delivery services, primarily covered individuals made an annual mean out of pocket(OOP) payments of $215, $142 and $357.7 respectively.

Conclusion:
The structure and modus operandi of the NHIS in Nigeria have not been properly streamlined and neither brought home to beneficiaries hence they still make considerable OOP payments to satisfactorily meet their health care needs. This raises a strong implication for reassessment of the scheme to ensure right focus and equitable delivery. It is also imperative that adequate information be made available to beneficiaries on the working of the scheme in order to maximise the benefits.