National Health Insurance Scheme And Health Benefits In Akwa Ibom State
The study is an attempt to investigate national health insurance scheme (NHIS) and health benefits in Akwa Ibom State. National Health Insurance Scheme (NHIS) in Nigeria is still considered as one of the several useful mechanisms through which the country can make progress towards achieving the goal of universal health coverage (UHC). This study attempts to reveal the various health insurance schemes that has been made available for indigenes of Akwa Ibom State. This study is descriptive survey research design. This consists of management and staff of the Zonal office of NHIS and the five selected HMOs selected for this study. The instrument used in collecting the data is the questionnaire. The findings revealed that residents in Uyo metropolis were aware of National Health Insurance Scheme; Civil servants in the state demonstrated a positive attitude towards National Health Insurance Scheme; and the level of uptake of National Health Insurance scheme among civil servants in Uyo Local Government Area was very low. It was therefore recommended among others that although, awareness is high, however there should be intensive sensitization and mobilization on utilization by the health department. Also there is need for government to increase funding of the scheme, as this would help to increase the health delivery services for which the scheme was created.
Table Of Contents
- Title Page
- Table of Content
- 1.1 Background of the study
- 1.2 Statement of problem
- 1.3 Objectives of the study
- 1.4 Research questions
- 1.5 Hypotheses
- 1.6 Significance of study
- 1.7 Scope and limitations of the study
- 2.1 An overview of Healthcare Service Delivery in Nigeria
- 2.2 Objectives of National Healthcare Service Delivery
- 2.3 Imperatives of free Healthcare Services
- 2.4 Financing of Healthcare Services in Nigeria
- 2.5 National Health Insurance Scheme
- 2.6 National health Insurance Scheme Programmes
- 2.7 Excluded Services
- 2.8 Management of National Health Insurance Scheme
- 2.8.1 Organisation structure
- 2.8.2 National Health Insurance Council
- 2.8.3 Health Maintenance Organizations
- 2.8.4 Health Service Providers
- 2.8.5 Funding of NHIS
- 2.8.6 Procedures and Coverage
- 2.9 Benefits of NHIS
- 2.10 Evaluation of NHIS
- 3.1 Research Design
- 3.2 Location of Study
- 3.3 Sources of Data
- 3.4 Population
- 3.5 Sample Size Determination and Sampling Technique
- 3.6 Instrument of data collection
- 3.7 Data collection procedure
- 3.8 Analytical Technique
Data Presentation and Analysis
- 4.1 Presentation of Data
- 4.2 Analysis of Data
- 4.3 Test of hypotheses
Summary, Conclusion and Findings
- 5.1 Summary of Findings
- 5.2 Conclusion
- 5.3 Recommendations
1.1 Background Of The Study
One of the basic needs of the people of any nation is good health. This incorporates physical fitness, adequate nutrition and food security, high life expectancy, absence of epidemic and endemic disease and efficient healthcare service delivery. Mfon (2005:21) expresses that a nation with an effective healthcare system is a wealthy nation and is development –oriented in the social context. In Nigeria, however, the health situation is a manifestation of malnutrition and low life expectancy for the majority, high incidence of epidemics and endemic diseases as well as inefficient healthcare service delivery.
It is in recognition of the significance of good health system that the Nigerian government has been consistent in its quest for an efficient healthcare delivery to be perpetually established in Nigeria.
It has been emphasized that no meaningful development can take place in the country if the greater proportion of the populace have no access to effective healthcare services and live in squalor and disease. The rapidly growing population therefore need adequate healthcare services for effective physical and intelligence development. Lambo (2006:12) observes that there was a sharp contradiction in the nations healthcare services in the periods of 1960s/70s and 1980s/20002. in the former, healthcare delivery was an effective term of cost and coverage with the government catering adequately for the cost of health services. But since the 1980s, the financing of health services has risen so much that the government has found it difficult to bear the burden in much the sand way was it did in the earlier periods.
Ugbanmadu (2003:24) observes that health services have become a matter of concern to the government given the dividing finances of the government which began in the 1980s.
Thus, when the Obsanjo administration came into being on May, 29 1999 the nation’s health sector was near comatose. Hospitals were in bad shape. Community and inter-sectoral collaboration was minimal. Ugbaja (2007:19) remarks that resources devoted to this vital social services were insufficient. Worst still, there was outright inadequacy of drugs and other consumables in most government health facilities. There was also paucity of qualified manpower in the government hospitals. The available ones were not motivated while facilities and equipment were poorly maintained.
Other lapses of the past included inadequate manpower development to meet modern trend and improper monitoring of services rendered to the public among others. From inception, therefore, it was clear to Obasanjo’s administration that the sector needed an urgent surgical operation.
Consequently, Oduenyi (2002:42) notes that in October 2003, federal Government organized a national conference on Alternative Healthcare financing in Nigeria. Participants were drawn from private and public health institutions and agencies through out Nigeria. They examined the inadequacies of health service, the casual factors as well as remedies for inadequate health services financing in Nigeria. Interalia, the conference ended with a call for improved health services financing.
Thus, in line with economic reforms in the country, health sector reform gained momentum with adequate health service financing as its cardinal objective, this resulted in the inception of the National Health Insurance Scheme (NHIS) on June 6, 2003 by ex-president Olusegun Obasanjo. The scheme had earlier been launched by the then Head Of State, late General Sani Abacha on 15th October,1997.
1.2 Statement Of Problem
The National Health Insurance Scheme (NHIS) is faced with several problem which hampered its effective implementation in the health sector.
First, there are administrative problems which consist in the delay of remittances from government and government establishments to the National Health Insurance Scheme (Council) and from the NHIS to Health Maintenance Organizations (HMOS) down to Health service providers.
Second, there are inadequacies of health facilities and medical personnel to cover the nation sufficiently under the scheme. This is due to limited number of HMOs and HSPs registered in the scheme.
Thirdly, many Health Service providers are either withdraw from the scheme or refusing to accept new enrollees.
Again, inadequate Logistic support facilities from the government and donor-agencies limit the coverage of the scheme so far to the public sector thus leaving the larger private sector out of the scheme.
Finally, there is public skeptism and apathy towards insurance in general and widespread ignorance about social health insurance. All these problems militate against effective implementation of the NHIS in Nigeria.
1.3 Objectives Of The Study
The objective of this study is to examine the National Health Insurance Scheme and health benefits in Akwa Ibom State.
Specifically, the objectives of the study are;
- To find out why the national Health Insurance Scheme was established.
- To examine the goals of the National Health Insurance Scheme.
- To find out how the NHIS is managed.
- To find out how the scheme is funded
- To establish the benefits of the NHIS
- To make recommendations on the problems and prospects of the NHIS in Nigeria.
1.4 Research Questions
The research is set to address the following problems;
- Why was the National Health Insurance Scheme established?
- What are the goals set to be achieved by the National Health Insurance Scheme?
- How is the NHIS managed?
- How is the NHIS funded
- What are the benefits of the NHIS?
- What are the problems and prospects of the NHIS in Nigeria?
1.5 Formulation Of Hypotheses
The following hypotheses are formulated for the study;
- H0: The NHIS is not established because of inefficient and poor state of the nation’s health care system.
H1: The NHIS is established because of inefficient and poor state of the nation’s healthcare system.
- H0¬: The NHIS is not armed to achieve improved healthcare service delivery
H1: The NHIS is armed to achieve improved healthcare services delivery
- H0: A major problem of the NHIS is not inadequate government commitment.
H1: A major problem of the NHIS is inadequate government commitment.
1.6 Significance Of The Study
The study will be useful to the following
- National Health Insurance Scheme Council (NHISC) the regulatory body of the NHIS will find study useful. This is because it will identify all the constraints to effective implementation of the scheme especially as it effects HMOs and HSPs. The regulatory aspect of these challenges will be established in this study so that the NHISC will take remedial measures. the recommendation of this study will be useful in this regard.
- Health Maintenance Organization (HMOs): These organizations will also benefit from this study. This is because it will not only highlight the challenges facinf them under the scheme but will also provide useful information on how they can effectively address these challenges especially those arising from their internal constituencies
- Health services providers. (HSPs): These private health institutions will also benefit from this study. Those already operating under the scheme will be provided with useful information on how to brace up with their challenges while those not yet operating under the scheme will find in this study the need to be integrated into the national healthcare delivery system via the NHIS.
1.7 Scope And Limitations Of The Study
This study focuses on the National Health Insurance Scheme and health benefits in Akwa Ibom State.
The limitations of the study include:
1. Difficulty of collecting primary data:
This followed from uncooperative attitude of most the staff of the organizations take into the study. Their refusal to complete the questionnaire or too be interviewed limited the volume of data available for this study.
2. Inadequate finance:
The study could have been very extrusive HMOs and HSPs were including in the study. This could have entail making more expenses which the researcher could not afford, hence the restriction of the study to only 8 of such organizations and NHIS zonal office in Akwa Ibom.
Summary, Conclusion And Findings
5.1 Summary Of Findings
The major findings of the study are summarized as follows:
The National Health Insurance Scheme was established because the healthcare system is generally in a poor state, the burden of healthcare services is so much on the government, inadequate funding of the healthcare system, cost of healthcare services is very high and there is need for effective integration of private health institutions into the nation’s healthcare system
The goals of the NHIS is to give all Nigerians access to good healthcare services, ensure high standard of healthcare services, ensure adequacy of funds for the health system, and make health costs and facilities equitably distributed across the nation.
The institutions managing the NHIS are the National Health Insurance Council (NHIC), Health Management organizations (MHOs) and Health service providers (HSPs).
The NHIC provides the guidelines for operations the scheme, registers and supervise defaulting HMOs.
The HMOs contract HSPs into the scheme make payment to HSPs, supervises HSPs and render periodic report to NHIC.
The HSPs provide medical personnel, facilities and services and receive capitation
The NHIS is funded through joint contribution by government and employees as well as fee-for service charge.
The problems of the NHIS include delay or nonpayment of capitation and fee-for service to the respective to the respective HSPs, poor attitude of HSPs to beneficiaries, non-acceptance of capitulation system of payment by HSPs among others.
There are prospects for the success of the scheme and this consists in the increasing acceptance of the scheme, increasing number of enrollees and HSPs as well as increasing funding of the scheme. Others are increasing spread of the scheme and increasing commitment by he government and donor agencies.
The National Health Insurance Scheme was introduced against the background of the general poor state of the nation’s health sector. The scheme is therefore designed to improve healthcare services/ delivery in Nigeria through increased funding and improved access to good healthcare by all Nigerian registered with the scheme. The scheme is considered very necessary as it will ensure improved healthcare services at reduced costs.
The scheme is designed to inject private sector managerial efficiency in Nigeria health sector through health maintained organizations. There are Prospects for the success of the scheme which has been rated as being effective so far.
- Government should ensure that all dedications and contributions made for the scheme are promptly remitted to the National Health Insurance Council which in turn should promptly remit the funds to health maintenance organizations’ band accounts
- Health Maintenance organizations should regular and promptly pay their financial obligations to the Health service providers. This will encourage the latter not only to accept more enrollees but to give them maximum medical attention at all times.
- Health services providers should be encouraged to accept and promote the capitation system of payment because of its revenue generation potential. Payment of capitation, fee-for – services and per diem should be wholly accepted by the respective HSPs.
- The government should extend the scheme to the private sector immediately. It should not longer Nigerians should be sufficiently enlightened to embrace the scheme because of its virtues
- Health service providers should cultivate the culture of good public relations or customer relations. Adequate and sufficient attention should always to given to beneficent attention should always to beneficiaries as their satisfaction is the basis of the success of the scheme.
- The NHIC Should step up its supervision of HMOs since many of them are not operating effectively. Those that cannot change positively should deregistered.
- Similarly, HMOs should effectively supervise and mentor. The HSPs to ensure that they adequately serve the enrollees.
National Health Insurance Scheme And Health Benefits In Akwa Ibom State
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