Group 8.docx

**FACULTY OF PHARMACEUTICAL SCIENCES** **DEPARTMENT OF CLINICAL PHARMACY,** **UNIVERSITY OF ILORIN** **COURSE CODE: PCP 312** **COURSE TITLE: PHARMACY ETHICS AND JURISPRUDENCE** **LECTURER-IN-CHARGE: Dr WILLIAMS** **TOPIC: NATIONAL HEALTH INSURANCE SCHEME/AUTHORITY** **GROUP EIGHT MEMBERS**...

**FACULTY OF PHARMACEUTICAL SCIENCES** **DEPARTMENT OF CLINICAL PHARMACY,** **UNIVERSITY OF ILORIN** **COURSE CODE: PCP 312** **COURSE TITLE: PHARMACY ETHICS AND JURISPRUDENCE** **LECTURER-IN-CHARGE: Dr WILLIAMS** **TOPIC: NATIONAL HEALTH INSURANCE SCHEME/AUTHORITY** **GROUP EIGHT MEMBERS** **NAME:** **OLOWOLAGBA Shalom 20/21PN074** **OLOJEDE Joseph 20/21PN072** **OLAWORE-JAMIU Hawwa 20/21PN07O** **OLADELE Samuel 20/21PN067** **OLAWOYIN Omogbolade 20/21PN071** **OYEWOLE Adedamola 20/21PN076** **OYEWOLE Oyegbemisola 20/21PN077** **OLUFEMI Oluwakemi 20/21PN075** **OLATEJU Tomisona 20/21PN068** **OLAOYE Isaac 20/21PN067** **TABLE OF CONTENT** 1. Introduction to National Health Insurance Authority. 2. Background of National Health Insurance Authority. 3. Goals and Objectives of the National Health Insurance Authority. 4. Functions of the Authority. 5. Subscribers of National Health Insurance Authority. 6. Funding of the National Health Insurance Authority. 7. Health care facilities endorsed by the National Health Insurance Authority. 8. Benefits of NHIS. 9. How does the NHIA function and its impact on healthcare services? 10. Conclusion. **Introduction** National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or statutory health insurance does not equate to government-run or government-financed health care but is usually established by national legislation. The NHIS offers programs tailored to different population segments and has undergone reforms to improve coverage and service delivery The National Health Insurance Scheme (NHIS) is a social intervention program introduced by the government to provide financial access to quality health care for residents in the country. The National Health Insurance (NHIS) Scheme is a Social Health Insurance program designed by the Federal Government of Nigeria to complement sources of financing the Health Sector and to improve access to Health care for the majority of Nigerians. The National Health Insurance Scheme (NHIS) in Nigeria was established in 1999 to provide affordable and quality healthcare services for all citizens. It operates by pooling funds from various sources, including contributions from individuals, employers, and the government, to provide healthcare coverage. The NHIS offers programs tailored to different population segments and has undergone reforms to improve coverage and service delivery. National Health Insurance Scheme (NHIS Nigeria) is a corporate body that provides accessible, affordable, and universal health care services to all Nigerians. NHIS\'s primary function is to protect families in Nigeria from financial barriers as they seek health care. Challenges remain, such as low enrollment rates and funding issues, but the NHIS remains a critical component of Nigeria\'s healthcare system, working towards universal health coverage. **NATIONAL HEALTH INSURANCE AUTHORITY** The National Health Insurance Authority (NHIA) was established under the National Health Insurance Act 2003, Act 650. 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 a 'subsidy for health insurance coverage for vulnerable persons and payment of health insurance premiums for indigents' law, Act 852 has replaced Act 650 in October 2012 to consolidate the NHIS, remove administrative bottlenecks, introduce transparency, reduce opportunities for corruption and gaming of the system, and make for more effective governance of the schemes. The NHIA will 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 the majority 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 and supplying safe, affordable medicines and vaccines, and so aiding in the attainment of Universal Health Coverage. **GOALS AND OBJECTIVES OF THE NATIONAL HEALTH INSURANCE AUTHORITY (NHIA)** **The main objectives of the scheme as set out in Act 35 of 1999 are:** 1. **Universal Health Coverage (UHC):** The NHIS aims to ensure that all Nigerians have access to affordable and quality healthcare services without facing financial hardship. 2. **Equitable Access**: It seeks to provide equal access to healthcare services for all citizens, regardless of their socio-economic status, geographical location, or pre-existing health conditions. 3. **Financial Protection**: The NHIS aims to protect individuals and households from the financial burden of healthcare expenses by pooling funds and providing prepaid health services. 4. **Improving Healthcare Quality**: It strives to enhance the quality of healthcare services by setting standards, accrediting healthcare providers, and monitoring the delivery of care to ensure adherence to established guidelines. 5. **Reducing Out-of-Pocket Spending**: The NHIS aims to reduce the reliance on out-of-pocket payments for healthcare services, which can lead to financial hardship and inequitable access to care. 6. **Promoting Preventive Care**: It encourages the provision of preventive healthcare services to reduce the incidence of diseases and promote overall population health 7. **Enhancing Efficiency and Accountability**: The NHIS seeks to improve the efficiency and accountability of the healthcare system by promoting transparency, strengthening governance mechanisms, and combating fraud and abuse. **OBJECT OF THE AUTHORITY** The object of the Authority is to attain universal health insurance coverage concerning: 1. Persons resident in the country 2. Persons not resident in the country but who are on a visit to this country 3. To provide access to healthcare services to the persons covered by the Scheme. **FUNCTIONS OF THE AUTHORITY** The object of the Authority is to secure the implementation of a national health insurance policy that ensures access to basic healthcare services to all residents. To achieve its objective, the Authority may: 1. Implement, operate and manage the National Health Insurance Scheme 2. Determine in consultation with the Minister contributions that members of the National Health Insurance Scheme should make; 3. Register members of the National Health Insurance Scheme; 4. Register and supervise private health insurance schemes 5. Issue identity cards to members of the National Health Insurance Scheme 6. Ensure equity in health care coverage 7. Ensure access by the poor to healthcare services 8. Ensure protection of the poor and vulnerable against financial risk 9. Grant credentials to healthcare providers and facilities that provide healthcare services to members of the National Health Insurance Scheme 10. Manage the National Health Insurance Fund 11. Provide a decentralized system to receive and resolve complaints by members of the National Health Insurance Scheme and healthcare providers 12. Receive, process and pay claims for services rendered by healthcare providers 13. Undertake public education on health insurance on its own or in collaboration with other bodies 14. Make proposals to the Minister for the formulation of policies on health insurance 15. Undertake programs that further the sustainability of the National Health Insurance Scheme 16. Develop guidelines, processes and manuals for the effective implementation and management of the National Health Insurance Scheme 17. Ensure the efficiency and quality of services under the national and private health insurance schemes 18. Protect the interest of members of private health insurance schemes 19. Identify and enrol persons exempt from payment of contribution to. National Health Insurance into the National Health Insurance Scheme 20. Monitor and ensure compliance with this Act and any Regulations, guidelines, policies, processes and manuals made under this Act 21. Perform any other function conferred on it by this Act or that are ancillary to the object of the Authority. **SUBSCRIBERS OF THE NATIONAL HEALTH INSURANCE AUTHORITY** NHIA subscribers fall into two broad groups, the informal and exempt groups. It is only the informal group that pays the premium. Members of the exempt group do not pay premiums. They are: 1. Formal sector employees and the self-employed who contribute to the Social Security and National Insurance Trust (SSNIT contributors) 2. Children (persons under 18 years of age) 3. Persons in need of ante-natal, delivery and post-natal health care services (pregnant women) 4. Persons classified by the Minister for Social Welfare as indigents, 5. Categories of differently-abled persons determined by the Minister responsible for Social Welfare 6. Persons with mental disorder 7. Pensioners of the Social Security and National Insurance Trust (SSNIT pensioners) 8. Persons above seventy years of age (the elderly) 9. Other categories of people prescribed by the Minister. In addition to the premium, subscribers are also required to pay a processing fee or renewal fee for their ID cards, except for pregnant women and indigents. **FUNDING OF NATIONAL HEALTH INSURANCE AUTHORITY** The NHIA is largely funded by: 1\. The National Health Insurance Levy (NHIL), which is a 2.5% levy on goods and services collected under the Value Added Tax (VAT). 2\. 2.5% Percentage points of Social Security and National Insurance Trust (SSNIT) contributions per month. 3\. Return on National Health Insurance Fund (NHIF) investments. 4\. Premium paid by informal sector subscribers. 5\. Government allocation complements the funding of the scheme. **HEALTHCARE FACILITIES ENDORSED BY NATIONAL HEALTH INSURANCE AUTHORITY** Several categories of healthcare facilities have been credentialed by the National Health Insurance Authority (NHIA) to provide services to subscribers. All providers are expected to provide counselling as an integral part of quality care. These are: 1. Community-based Health Planning and Services (CHPS) 2. Maternity homes 3. Health centers 4. Clinics 5. Polyclinics 6. Primary hospitals (district hospitals, CHAG primary hospitals, Government primary hospitals and private primary hospitals) 7. Secondary hospitals 8. Tertiary hospitals 9. Pharmacies 10. Licensed chemical shops 11. Diagnostic centers **NHIS BENEFITS** The NHIS enrollees are entitled to the following benefits: 1. Out-patient care, including necessary consumables. 2. Prescribed drugs, pharmaceutical care and diagnostic tests- as contained in the National Essential Drug List and Diagnostic Test List. 3. Maternity care for up to four (4) live births for every insured contributor/couple in the Formal Sector Program. 4. Preventive care, including immunisation as it applies to the National Program on Immunization, health education, family planning, antenatal and post-natal care. 5. Consultation with specialists such as physicians, paediatricians, obstetricians, gynaecologists, general surgeons, orthopaedic surgeons, ear nose and throat (ENT) surgeons, dental surgeons, radiologists, psychiatrists, ophthalmologists, physiotherapists. 6. Hospital care in a standard ward for a stay limited to a cumulative 15 days per year in non-military Hospitals and no limit in Military Hospitals. The primary provider shall pay per diem for the bed space for a total of 15 days cumulative per year. Thereafter, the beneficiary and/or the employer Pay. 7. Eye examination and care excluding the provision of spectacles and contact lenses; a range of prostheses limited to artificial limbs produced in Nigeria. 8. Preventive dental care and pain relief including consultation, dental health education, amalgam filling, and simple extraction. **HOW DOES NATIONAL HEALTH INSURANCE AUTHORITY FUNCTION** The NHIA performs its function by: 1\. **Policy Development**: The NHIA formulates health insurance policies and strategies, taking into account the healthcare needs of the population, budgetary considerations, and the overall goals of the health system. This involves conducting research, analyzing data, and consulting with relevant stakeholders. 2\. **Program Implementation**: The NHIA is responsible for implementing the national health insurance program. This includes designing benefit packages, setting premium rates, establishing enrollment processes, and managing the provider network. The authority may also negotiate contracts with healthcare providers to ensure access to quality care. 3\. **Enrollment and Eligibility**: The NHIA manages the enrollment process, which involves registering individuals or households for health insurance coverage. It verifies eligibility criteria, such as citizenship, residency, or employment status, and maintains an up-to-date database of insured individuals. 4\. **Premium Collection**: The NHIA collects premiums from individuals, employers, or other funding sources, depending on the financing model adopted. It ensures that the collection process is efficient, transparent, and equitable. 5\. **Claims Processing**: The NHIA receives and processes claims from healthcare providers on behalf of insured individuals. It verifies the eligibility of the claimant, checks the validity of the services provided, and reimburses the healthcare providers accordingly. 6\. **Quality Assurance**: The NHIA may establish quality assurance mechanisms to ensure that healthcare services provided to insured individuals meet certain standards of quality and safety. This may involve monitoring provider performance, conducting audits, and implementing quality improvement initiatives. 7\. **Stakeholder Engagement**: The NHIA engages with various stakeholders, including government agencies, insurers, healthcare providers, and patient advocacy groups. It collaborates with these stakeholders to address challenges, gather feedback, and make necessary adjustments to the health insurance program. 8\. **Information Management**: The NHIA maintains a comprehensive information management system to support its operations. This includes managing data on insured individuals, healthcare providers, claims, premiums, and other relevant information. It also ensures the security and privacy of sensitive health data. **IMPACT OF NHIA TO HEALTHCARE SERVICES** 1\. **Investment and Insurance** Capabilities: NHIA can invest funds and insure private health schemes without tax, enhancing financial stability and service provision. 2\. **Mandatory Health Insurance**: Every legal resident of Nigeria is required to participate, regardless of employment status, addressing the limitations of the former NHIS law which was voluntary. 3\. **Reducing Inequality:** Mandatory health insurance aims to bridge income and wealth inequality, potentially improving the index of the country. 4\. **Minimizing Out-of-Pocket Payments**: Compulsory health insurance could significantly reduce wealth inequality caused by high out-of-pocket payments, which currently constitute 70% of health expenditures. 5\. **Equitable Health Services**: Ensures a minimum package of health services for all Nigerians, maintaining equity in healthcare delivery. 6\. **Integration of Health Schemes:** Ensures all health insurance schemes in Nigeria are integrated to address disparities in healthcare access and quality. 7\. **Support for Research and Technology**: Facilitates research, statistics generation, and use of information and communication technology to improve healthcare delivery. 8\. **Monitoring and Evaluation:** \- Regular Reviews and Evaluations: Guidelines are reviewed every five years, and tariffs to healthcare facilities are evaluated every three years to prevent losses due to inflation. \- Feedback Mechanism: Collects feedback from enrollees to address dissatisfaction and improve service delivery. 9\. **Establishment of Vulnerable Group Fund (VGF) and Basic Health Care Provision Fund (BHCPF):** \- Implementation: The NHIA collaborates with state health schemes and third-party administrators to implement the BHCPF in states without a state health insurance scheme. \- Revenue Mobilization: Sources for the VGF include BHCPF, health insurance levy, government allocations, investments, grants, donations, and gifts. \- Target Population: Aims to cover 83 million vulnerable Nigerians, significantly increasing coverage from the previous NHIS which served less than 5% of the population. 10\. **Financial Management and Accountability:** -State Health Insurance Schemes: Management of funds has been moved from HMOs to state health insurance schemes to prevent misuse and embezzlement, enhancing accountability and quality healthcare delivery. 11\. **Expanded Health Care Packages**: \- Additional Services: Includes treatment for cancers, emergency care, and stroke management, reducing financial burdens from unforeseen medical conditions. 12**. Increasing Awareness:** -Awareness Campaigns: Addresses the lack of awareness about health insurance, aiming to increase uptake and participation in health insurance schemes across Nigeria. **Challenges and Limitations Faced by the NHIA** These challenges highlight the significant obstacles that the NHIA faces in achieving its objectives of providing comprehensive and equitable healthcare to all Nigerians 1\. **Funding Issues**: \- Procuring health insurance for 83 million vulnerable Nigerians requires about N 1.3 trillion annually, double the 2022 health budget.\ - Poor financing is a major setback, with healthcare allocation in Nigeria being\ one of the lowest globally at 4.2%, against the 15% Abuja declaration recommendation.\ - High out-of-pocket payments and limited federal support narrow the success of NHIA\'s implementation.\ - Majority of Nigerians living below the poverty line may struggle to pay into the scheme, affecting the funding pool. 2\. **Supply Challenges**:\ - Poor healthcare coverage in rural and some urban areas due to inadequate facilities.\ - Shortage of skilled manpower and essential resources, with current ratios of 0.4 doctors, 1.5 nurses, and 0.5 hospital beds per 1,000 population.\ - Mass emigration of healthcare professionals due to poor working conditions exacerbates the issue. 3\. **Security Issues**:\ - Conflicts and insecurity from terrorism, banditry, and communal clashes hinder healthcare delivery.\ - Nigeria ranks low on the global peace index, impacting healthcare service provision. 4\. **Demand Challenges**:\ - Difficulty enforcing mandatory enrollment due to past negative experiences with NHIS.\ - Issues such as out-of-pocket payments, lack of specialized care, and dissatisfaction with quality deter enrollment. 5\. **Resource Requirements**:\ - Implementation needs significant human, material, and financial resources, which are currently inadequate.\ - Rapid population growth (2.5% annually) requires the enrollment rate to outpace population increase to achieve UHC. 6\. **Private Healthcare Integration**:\ - Challenges in incorporating private healthcare providers, crucial to the system, due to accreditation and payment issues.\ - Less than two-thirds of private facilities are accredited, and many providers regret joining previous schemes. 7\. **Healthcare Facility Utilization**:\ - Primary and secondary healthcare levels are not functioning optimally in most states, affecting accreditation and utilization.\ - Ensuring equitable patronage of healthcare facilities requires addressing these systemic issues. **\ CONCLUSION**: In summary, the NHIA has the undeniable potential to increase the life expectancy of Nigerians, contributing to economic growth and job creation, boosting national productivity, and reducing poverty. It will greatly halt the catastrophic and impoverishing health payments by vulnerable people, who would be able to now adequately access health services without suffering financial hardship. It is hoped that it will promote health-seeking behavior, decrease self-medication, prevent serious illnesses, and decrease mortality from preventable deaths that were hitherto widespread. **References:** 1. [**[https://journals.lww.com/npmj/fulltext/2022/29040/the\_nigeria\_national\_health\_insurance\_authority.1.aspx]**](https://journals.lww.com/npmj/fulltext/2022/29040/the_nigeria_national_health_insurance_authority.1.aspx) 2. [**[https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://nigeriahealthwatch.medium.com/universal-health-care-in-nigeria-accelerating-the-nhia-acts-implementation-dd055312c2a6%23:\~:text%3DAmong%2520other%2520things%252C%2520the%2520Act,the%2520provision%2520of%2520healthcare%2520services.&ved=2ahUKEwjQ7ZTG-ZyGAxWnxQIHHbrBA0sQFnoECAQQBQ&usg=AOvVaw1FaOt32GY9n94PEfD3jaRf]**](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://nigeriahealthwatch.medium.com/universal-health-care-in-nigeria-accelerating-the-nhia-acts-implementation-dd055312c2a6%23:~:text%3DAmong%2520other%2520things%252C%2520the%2520Act,the%2520provision%2520of%2520healthcare%2520services.&ved=2ahUKEwjQ7ZTG-ZyGAxWnxQIHHbrBA0sQFnoECAQQBQ&usg=AOvVaw1FaOt32GY9n94PEfD3jaRf) 3. **[[https://www.populationmedicine.eu/The-new-National-Health-Insurance-Act-of-Nigeria-How-it-nwill-insure-the-poor-and,157139,0,2.html]](https://www.populationmedicine.eu/The-new-National-Health-Insurance-Act-of-Nigeria-How-it-nwill-insure-the-poor-and,157139,0,2.html).** 4. **[[https://www.nhis.gov.ng/about-us/]](https://www.nhis.gov.ng/about-us/).** 5. [**[https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-2020]**](https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-2020) 6. [**[https://www.afro.who.int/countries/nigeria/news/nigeria-stakeholders-are-charting-sustainable-pathway-achieving-universal-health-coverage-all]**](https://www.afro.who.int/countries/nigeria/news/nigeria-stakeholders-are-charting-sustainable-pathway-achieving-universal-health-coverage-all) 7. [**[https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-%28uhc%29]**](https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-%28uhc%29)