CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF STUDY

The National Health Insurance Scheme (NHIS) is a type of formal sector social health insurance programme.  In this programme, the cost of health care for an employee is paid for by the contributions of both the employee and the employer, which makes it a social health security system. This is made possible by deductions of 5% of the employee’s salary and 10% of the employer’s salary paid out to the employee on a monthly basis, the whole resources are then used to cover the health expenditures of all those enrolled under the scheme. The concept also involves that of subsidization in which the young subsidize for the old, the rich subsidize for the poor and the healthy subsidizes for the ill.

The National Health Insurance Scheme aims at ensuring that every Nigerian has access to good healthcare services, protecting families from the financial hardship of huge medical bills. It also limits the rise in the cost of healthcare services, thereby maintaining high standard of healthcare delivery services within the system. It ensures both the efficiency in healthcare services and the availability of funds to the health sector for improved services, which guarantees equitable patronage of all of health care. The NHIS is seen as a complementary means of financing health care that is, to the government, international organisation and the whole community, a major factor necessary for the aim of achieving a worldwide level of good health that will lead to a productive and socially stable economy.

The benefits of implementing the Compulsory Health Insurance Scheme includes three aspects: the scheme provides for the pooling of resources for cross subsidization of health costs where those in high-income bracket subsidizes those in low income bracket1; the healthy subsidize the sick and the young subsidize the old; the burden of funding healthcare services is shared between government and private employers and enrollees. Quackery is also minimized owing to standards for personnel and equipment set for providers by the scheme.  Competition among healthcare providers to attract and retain clients leads to improvement in the quality of services. The scheme provides employment opportunities for health professionals in the healthcare delivery system and thereby reduces brain drain. Donor Agencies and/or government will have the confidence to donate to rural communities or less privileged through the proposed vulnerable group fund.  Improved services resulting from improved income reduces the need for overseas treatment, thereby conserving the country’s foreign reserve. Improved access to health care services creates a healthier work force for increased economic activities and national prosperity.  Communities and associations contribute for their health care services without viewing it as tax or levy, as they are the financial managers and administrators of their programme and reap the benefits from there.

Members who are enrolled in this scheme get to enjoy several benefits and services such as hospital care (limited to only 15 days in a year and admission in the general ward), outpatient care, pharmaceutical care as in NHIS essential drug list, diagnostic tests as in NHIS diagnostic test list, maternal care for up to four (4) life births; preventive care (immunisation, health education, antenatal and postnatal care), eye care and preventive dental care.2 Beneficiaries no longer need to pay for treatment with cash in health centers when required except for the 10% co-payment for the price of drugs.  This will reduce or even totally eliminate the usual habit of family members selling off their assets in order to generate money for treatment in emergency cases of life threatening conditions and illnesses. According to the ministry of health, it claims that the National Health Insurance Scheme is in fact the most comprehensive in the world owing to its benefit package.

However, Nigeria remains the country with the highest number of out-of-pocket payments for healthcare, yet the health system is still very poor. The poor state of the health system was what led to the initiation and establishment of the National Health Insurance Scheme by the Nigerian Federal State. In 1997, its policy was drafted by the Nigerian government, which was then signed into law in 1999 and was launched for implementation on 16th June 2005. People die daily from common illnesses, which can be easily treated owing to financial incapacity. Many individuals borrow or loan money, sell their properties, use up all of their personal savings just to ensure they can pay for their health care.

The major objective of the NHIS was to ensure that it covers all indigent Nigerians across the country with the purpose of delivering a comprehensive and affordable healthcare nationally. It comprises employers, employees, self-employed, unemployed and rural communities. The Nigerian health insurance scheme only covers 4% of the population, which is significantly low. Nine states have indicated interest in the scheme (Abia, Enugu, Gombe, Imo, Jigawa, Kaduna, Lagos, Ondo and Oyo) but only two states (Bauchi and Cross-river) attempted to enrol their employees in the scheme. The aim of this study was to identify the problems associated with the utilisation of the health insurance scheme.

The Nigerian National Health Insurance scheme (NHIS) is planned to attract more resources to the health care sector and improve the level of access and utilization of healthcare services. It is also intended to protect people from the catastrophic financial implications of illnesses. However, whether it will work in practice and whether the present model of the NHIS is appropriate is also a matter of diverse opinions.

1. STATEMENT OF THE PROBLEM

Similar to the USA, Nigeria is not without its challenges in the efforts to expand a nation-wide social health insurance programme (Peterson, 2011; Steinmo and Watts, 1995). However, social health insurance is long established in other developed places such as the UK as well as in many other European countries (Normand and Busse, 2002).

Before the creation of the National insurance scheme most patients were made to pay for the full cost of medication and care. The National health insurance was to generate revenue and to discourage frivolous use of health care services. The poor especially, were undertaking self-medication and also reporting late to health facilities for treatment because they could not afford to pay the medical fees.

However, no research has been done on National health insurance scheme and it health care benefit, most research were only on National health care insurance scheme, Reason why this research is carried out to examine National health insurance scheme and it health care benefit.

1. AIMS AND OBJECTIVES

The main aim of the study is to examine National health insurance scheme and health care benefit. Other specific objectives include:

1. to determine the relationship between National health insurance scheme and health care  benefit in Akwa ibom State.

2. to examine the health care benefit of National health insurance scheme in Akwa ibom State.

3. to investigate the Prospects and Challenges of Health Insurance in Akwa ibom State.

4. to proffer solution to the Challenges of Health Insurance in Akwa ibom State.

1. RESEARCH QUESTIONS

1. What is the relationship between National health insurance scheme and health care benefit in Akwa ibom State?

2. What is the health care benefit of National health insurance scheme in Akwa ibom State?

3. What are the Prospects and Challenges of Health Insurance in Akwa ibom State?

4. What is the solution to the Challenges of Health Insurance in Akwa ibom State?

1. STATEMENT OF RESEARCH HYPOTHESIS

1. H0: there is no significant relationship between National health insurance scheme and health care benefit in Akwa ibom state.

2. H1: there is a significant relationship between National health insurance scheme and health care benefit in Akwa ibom state.

1. SIGNIFICANCE OF STUDY

The study will be of benefit to every citizen in Nigeria especially those in Akwa ibom state, they will be aware of the National health insurance scheme and it health care benefit, the poor in the society can have access to a good health care services at a low or no cost at all.

The study will serve as an enlightenment to the immense benefit package of the National health insurance scheme (NHIS) which consists of basic health care services, including outpatient consultations, essential drugs, inpatient care and shared accommodation, maternity care (normal and caesarean delivery), eye care, dental care, and emergency care. The study will be in the archive of knowledge and serve as a research tool for further study by other researchers.

1. SCOPE OF STUDY

The scope of this study will cover National health insurance scheme and health care benefit in Akwa ibom State.

1. LIMITATION OF STUDY

1. Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

2. Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1. DEFINITION OF TERMS

National health insurance scheme: The National Health Insurance Scheme (NHIS) is a body corporate established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost.

Health care:  healthcare is the maintenance or improvement of health via the prevention, diagnosis, treatment, recovery, or cure of disease, illness, injury, and other physical and mental impairments in people.

Benefit: an advantage or profit gained from something