Finding balance in Nigeria's mandatory health insurance

Abstract

The question of sustainable financing for health-service delivery in Nigeria has been at the forefront of health discussions throughout the year.1Ezenwaka U Gatome-Munyua A Nwankwor C et al.Strategic health purchasing in Nigeria: investigating governance and institutional capacities within federal tax-funded health schemes and the formal sector social health insurance programme.Health Syst Reform. 2022; 8e2074630Google Scholar This discussion is against the backdrop of an overwhelming gap in health financing in the country,2Alawode G Adewoyin AB Abdulsalam AO et al.The political economy of the design of the Basic Health Care Provision Fund (BHCPF) in Nigeria: a retrospective analysis for prospective action.Health Syst Reform. 2022; 82124601Google Scholar and its effect on the quality of Nigerian health-service delivery. The passage of the National Health Insurance Authority bill into law in May, 2022, making health insurance mandatory, and including a vulnerable group fund as one source of financial funding, has brought the question of health financing into sharper focus. The authors of the Lancet Nigeria Commission3Abubakar I Dalglish SL Angell B et al.The Lancet Nigeria Commission: investing in health and the future of the nation.Lancet. 2022; 399: 1155-1200Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar and other health financial experts have continuously called on governments to strategically finance health care through reorganised payment systems, increased strategic funding, and investment approaches such as the Basic Healthcare Provision Fund gateway, ring-fencing health-related taxes, such as the 10% carbonated drink tax proposed in the 2021 Finance Act.4PricewaterhouseCoopersNigeria's finance act 2021.https://www.pwc.com/ng/en/publications/nigeria-finance-act-2021.htmlDate: 2021Date accessed: November 2, 2022Google Scholar But the loudest call is for private sector involvement. In his Comment (November, 2022),5Awosusi A Nigeria's mandatory health insurance and the march towards universal health coverage.Lancet Glob Health. 2022; 10: e1555-e1556Summary Full Text Full Text PDF Scopus (1) Google Scholar Abiodun Awosusi takes an optimistic view about private sector involvement as a catalyst for universal health coverage in Nigeria. Although private sector involvement helps broaden the possibilities for resource mobilisation, it has been established that public investment remains the surest way to achieve sustainable financing for health-service delivery.3Abubakar I Dalglish SL Angell B et al.The Lancet Nigeria Commission: investing in health and the future of the nation.Lancet. 2022; 399: 1155-1200Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar In a challenging economic environment, the capacity of the private sector to be responsive to this role as catalyst remains to be seen. The argument of the opportunities for expanding private sector investment in health insurance, especially within the new framework from the National Health Insurance Authority that places a premium on expanding coverage by pooling resources for the greater good, and which moves forward to re-enforce the social contract between government and the people towards achieving health rights, will require a value re-orientation for those in the private sector or who are intending to move into the sector. At best, the private sector represented by health maintenance organisations in the old regime were undertaking retainership rather than health insurance. A balancing act needs to be thought through to ensure that the private sector realises its profit aspirations and the social goals of the new health insurance regime. The present economic outlook does not bode well for divesting private equity. The onset of new risks—ie, inflation, rising interest rates, geopolitical turmoil, and increased government scrutiny—has contributed to the surge in volatility and slowdown in private equity adventures in 2022.6PricewaterhouseCoopersPrivate equity: US deals 2023 outlook.https://www.pwc.com/us/en/industries/financial-services/library/private-equity-deals-outlook.htmlDate: 2022Date accessed: November 10, 2022Google Scholar The opportunities in the health sector keep expanding—from technology and e-services, to financial services. However, it is estimated that 133 million people now suffer multidimensional poverty, meaning that the ability of Nigerians to pay health insurance is diminishing by the day, and the vulnerable fund will have to cater to an increasing number of citizens.7National Bureau of StatisticsNigeria multidimensional poverty index.https://mppn.org/wp-content/uploads/2022/11/MPI_web_Nov15_FINAL.pdfDate: 2022Date accessed: November 2, 2022Google Scholar Funding from the public purse still remains relatively constrained. All of these factors make for uncomfortable projections for the market, but the possibilities are there: we just need to think them through. We declare no competing interests. Nigeria's mandatory health insurance and the march towards universal health coverageThe 2022 Lancet Nigeria Commission highlights the value of adequate investments in health as Nigeria undergoes key transitions.1 It provides compelling evidence on the need for a “new social contract”1 between the people and the state. This contract is crucial for the implementation of the National Health Act (NHA), the National Health Insurance Authority (NHIA) Act, and national strategies and plans for health. Full-Text PDF Open Access