Healthcare providers in Nigeria are calling for the implementation of a unified cost structure for private and public health insurance policies. They argue that such a move would significantly improve healthcare delivery across the country and expand health insurance coverage to more citizens.
Despite previous efforts to standardize health insurance policies and harmonize costs between the public and private sectors, significant operational disparities remain. Healthcare practitioners have noted that private health insurance plans, while offering more comprehensive coverage, tend to be more expensive. A unified cost approach, they suggest, would address these pricing disparities by integrating private and public health insurance policies under a single, standardized pricing model.
Recently, the Lagos Chapter of the Association of Community Pharmacists of Nigeria (ACPN) criticized the current payment structure and called for the adoption of the Lagos State Health Insurance Management Agency (LASHIMA) model. The LASHIMA model separates fees for professional services from capitation payments for other primary care services, which the ACPN argues would simplify the payment system and move Nigeria closer to achieving the Sustainable Development Goal of Universal Health Coverage.
According to Dr. Tolu Ajayi, Chairman of ACPN, a standardized fee structure would eliminate disparities between public and private healthcare services, ensuring high-quality care for all citizens, especially those in lower-income brackets. The proposed model would involve setting healthcare services or insurance premiums at a uniform rate across all providers, ensuring that patients pay the same amount for specific services or coverage, regardless of the provider.
Dr. Austin Aipoh, President of the Association of Nigeria Private Medical Practitioners, echoed this sentiment. He highlighted the challenges faced by private healthcare providers under the current fee structure, noting that it does not account for the additional costs borne by private sector providers, such as operational expenses and salaries. Aipoh suggested that the Federal Government should consider implementing a tiered fee structure or different capitation rates for private and public sector services to account for these unique financial burdens.
Aipoh also proposed the establishment of a specialized health bank to facilitate access to low-interest loans for private healthcare providers, similar to initiatives in other countries like India. This would help reduce the financial strain on private providers and support the growth of the private health sector in Nigeria.
In addition to advocating for a unified cost structure, Dr. Babatunde Rosiji, Chairman of the Nigeria Medical Association, South West chapter, emphasized the need for premiums and fee-for-service rates to be unified and renegotiated to reflect current economic realities. He argued that these adjustments are necessary to ensure that National Health Insurance Scheme (NHIS) patients receive quality care and are not subjected to substandard treatment in hospitals.
Rosiji also pointed out that the National Health Insurance Authority (NHIA), established by the NHIA Act of 2022, has been given new and expanded duties to regulate, implement, and invest in health insurance policies in Nigeria. He noted that once a health insurance enrollee pays the premium, the Health Maintenance Organization (HMO) pays the capitation to accredited healthcare providers on behalf of the enrollees, enabling them to access the health services covered by their plan.
Overall, the healthcare providers believe that implementing a unified insurance cost structure will create a level playing field for both public and private providers, ultimately leading to more equitable and accessible healthcare for all Nigerians.
