Abuja, Nigeria. 26th November 2024 – A new public opinion poll conducted by NOIPolls has revealed that only a handful of adult Nigerians (19 percent) are covered by health insurance policies in the country. Unfortunately, most adult Nigerians (79 percent) are not covered by the scheme as they pay out of pocket for healthcare. This corroborates Dataphyte’s publication of December 24, 2021, which reports that Health insurance has barely scratched the surface in Nigeria with regards to percentage coverage of the population as 97% of Nigeria’s population is not covered by any health insurance; the alternative to health insurance is huge out-of-pocket spending on health, and in 2018, Nigeria ranked the third highest country with the highest out-of-pocket health spending. 76.6% of health spending in the country was out-of-pocket.
The poll further revealed that a large proportion of Nigerians (86 percent) visit the hospital when ill with public hospitals (67 percent) being the most accessed facilities, while 32 percent of Nigerians use private hospitals. Furthermore, a percentage slightly above average (55 percent) disclosed that they are aware of the National Health Insurance Scheme while 32 percent revealed they are not aware of the scheme. While most adult Nigerians (72 percent) use the National Health Insurance Scheme (NHIS), 26 percent are covered by private Health Maintenance Organizations (HMOs). With regards to service delivery, 69 percent of adult Nigerians disclosed they are satisfied with the service provided by the health insurance provider, and 31 percent revealed their dissatisfaction citing complaints bothering “the services they provide” (29 percent), “they don't usually have drugs available” (26 percent), “poor service rendered” (25 percent), “low quality drugs” (14 percent), as well as “the amount they charge” (14 percent).
On the flip side, amongst Nigerians who do not visit the hospital when ill, 31 percent go to the pharmacy, 24 percent resort to self-medication, 22 percent go to a chemist, 12 percent go to traditional doctors, 5 percent call family doctors, while 4 percent pray or do nothing. Interestingly, 2 percent disclosed that they do not fall sick.
With regards to recommendations on how the Federal government can improve the National Health Insurance Scheme (NHIS), several suggestions were offered with the provision of good quality drugs (34 percent) as top mentioned. This is followed by “render good service” (15 percent), “attend to people on time” (11 percent), “proper monitoring by the government” (10 percent), and “reduction of charges” (7 percent). Interestingly, 59 percent of Nigerians interviewed expressed their willingness to pay a small amount to get enrolled into the health insurance scheme when asked if they would be willing to pay monthly or yearly for health insurance to access care when ill. These are some of the key findings from the Health Insurance Poll conducted in the week commencing 15th of January 2024.
Background
Health Insurance is a scheme that protects your health and gives you access to quality healthcare services for free. It covers your medical expenses for an agreed period while you pay monthly or annual premiums as a commitment.
It is one of the mechanisms for providing financial protection from the costs of using healthcare services. This is a key pillar of universal healthcare. The protection it affords is extremely important as research from the World Bank and the WHO showed that 100 million people are pushed into extreme poverty on an annual basis due to healthcare expenses. While health insurance has been operational in Nigeria for over 15 years, the uptake has remained low. As of 2016, only 3% of healthcare expenditure in Nigeria was paid for using health insurance. According to the leadership of the National Health Insurance Scheme (NHIS), the scheme covers less than 5% of Nigerians. The enrolee population in the scheme is largely made up of Federal Government employees and their dependents. To bridge the coverage gap, The Nigerian government signed into law the new National Health Insurance Act (NHIA) 2022 on 19 May 2022. The NHIA replaced the National Health Insurance Scheme Act of 1999, which failed to enroll more than 10% of the population.
The NHIA seeks to promote, regulate, and integrate health insurance schemes. It aims to secure mandatory health insurance for every Nigerian and legal resident and establishes a fund for the vulnerable groups, which will provide ‘subsidy for health insurance coverage for vulnerable persons and payment of health insurance premiums for indigents. The inclusion of vulnerable groups will increase health-seeking behaviour and access to quality healthcare among this group.
Furthermore, NHIA seeks to create health insurance schemes in states that do not have them and the accreditation of primary and secondary healthcare facilities that are more accessible to the population. These healthcare facilities are imperative in achieving Universal Health Coverage (UHC), given their proximity and easy accessibility by people living in rural and semi-urban areas, with most of these facilities owned by the government. They provide comprehensive, good-quality care that meets patients’ needs and covers basic health services for disease prevention, health promotion, and health maintenance, including offering basic diagnostic tests, supplying safe, affordable medicines and vaccines, and so aiding in the attainment of UHC.
Currently, the National Health Insurance Scheme (NHIS) and private Health Maintenance Organizations (HMO) operate side by side in Nigeria. There are 58 HMOs registered with the NHIS, of which 49 (77.6%) of them have a nationwide presence. Considering this, NOIPOlls surveyed to gauge the perception of Nigerians on health insurance schemes in the country.
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