Health Care Financing in Nigeria: An Assessment of the National Health Insurance Scheme (NHIS)

Abstract

How a nation finances its health care delivery system could be a clear parameter in assessing the premium placed on its people’s health. As a critical developmental component like food, shelter and clothing, the health sector requires adequate funding. However, the funding of health care system varies across different countries. In the case of Nigeria, the financing of the health care delivery system is majorly through tax revenue, out-of-pocket payment or user fees, donor funding and social health insurance. The federal government introduced the National Health Insurance Scheme (NHIS) because it considered funding health so demanding due to dwindling economy, perennial shortage of qualified and competent health personnel, shortage of drugs and other health infrastructures. More importantly, the introduction of the scheme was to guarantee good and qualitative access to efficient health care services such that it could reduce catastrophic household out-of-pocket health expenditure. Since its inception and resuscitation, several states across the country have keyed into it. However, actual implementation of the scheme by these states appeared not to have commenced fully. While this paper identified the various major sources of health care financing in Nigeria, its focal point was on the NHIS. Consequently, a framework for explaining the impact of the scheme within the context of Nigeria was designed through a triangulation of Structural Functionalist and Rational Choice Theories. The major findings about NHIS from the cross-sectionalized review of the empirical studies conducted across Nigeria revealed among others that the level of awareness of the scheme among the target population in some states was high while a couple of states recorded low-level knowledge of the scheme. In addition, the introduction of the scheme has tremendously scaled up the patronage and utilization of health facilities and reduction in out-of-pocket expenditure for health services rendered. This paper therefore recommended among others that the government in collaboration with relevant partners should intensify optimal awareness and education on the scheme to all Nigerians. It also suggested increased funding for the scheme through budgetary allocation to the health sector.

Keywords: Health care financing, National Health Insurance Scheme; and Impact