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ASSESSMENT OF BENEFITS AND CHALLENGES OF NATIONAL HEALTH INSURANCE SCHEME ( NHIS) AS A TOOL FOR ACHIEVING UNIVERSAL HEALTH CARE IN KWARA STATE NIGERIA
1.1 Background to the Study
Several approaches abound in financing healthcare. These range from fees for service to private insurance, general taxation, social insurance, community financing, loans and grants. In Nigeria, combinations of all these in different proportions have been practiced for decades. The most basic form of health care financing is that of fees for service, where a fee is charged to cover all or part of the cost of the service provided. In many low and middle income countries a fixed fee for service, known as a user charge, is used by government health facilities, both as a means of raising revenue and as a means of discouraging what may be viewed as ’unnecessary demand’. This form of health care financing has a number of disadvantages. The direct payment of fees for service is regressive in that it causes the greatest hardship for the poor, and may cause major difficulties in payment for waged labourers, who are unpaid during sickness (Goodman, 1993).
The rising cost of health care services as well as the inability of the government health facilities to cope with the people’s demand necessitated the establishment of National Health Insurance Scheme (NHIS). The start of the NHIS dates back to 1962 when the need for health insurance in the provision of health care to Nigerians was first recognized (Akande and Bello, 2002; Katibi and Akande, 2003). It was fully approved by the Federal Government in 1997, signed into law in 1999 and launched officially on the 6th June 2005. The Scheme is designed to provide comprehensive health care delivery at affordable costs, covering employees of the formal sector, self employed, as well as rural communities, the poor and the vulnerable groups a fee for service system with government funds supplementing in capital project financing. External loans and grants in form of technical assistance and free drugs especially for preventive services are common in Nigeria. The Global fund for HIV/AIDS, Malaria and Tuberculosis is one of such initiatives. Immunization campaigns are also supported by donor agencies. So far, the common man is yet to get the best of healthcare in Nigeria. The fee for service system takes so much from his pockets and leaves him unprepared for most medical expenses.
As a result of the possibility of very high and unpredictable medical costs, many users of the fee for service system arrange cover through private insurance schemes, where the risk of illness is pooled among the insured group. Private insurance schemes attempt to spread the risk of illness over all insurees and as such discriminate less against the sick than pure fee based systems (Green, 2007). Social insurance schemes on the other hand widen the base of private schemes with payments tied to wage levels. Contributions to the scheme are made by employees, employers, and in some cases the state.