NHIA Tackles Capitation Fees and Expands Vulnerable Group Support
By Patience Ikpeme
The Federal Government is reviewing the capitation fees paid to healthcare providers under the national health insurance programme.
Capitation fees are the payments made to doctors, hospitals, and other providers based on the number of patients they serve.
Dr. Kelechi Ohiri, Director-General of the National Health Insurance Authority (NHIA), revealed that these tariffs have remained unchanged for years, necessitating an urgent review. “It’s been a while since tariffs were reviewed. We initiated actuarial reviews in February to have a solid foundation for adjusting these tariffs,” he said.
The goal of these reviews is to determine an affordable basic minimum package of services for patients, ensuring consistent and predictable healthcare services at hospitals.
Alongside the capitation fee review, the NHIA is also enhancing its support for vulnerable groups to boost their participation in the health insurance program. The Vulnerable Group Fund, part of the NHIA’s mandate, provides coverage for the poor, people with disabilities, internally displaced persons, the elderly, and other at-risk populations, including women facing high risks during childbirth.
“The Vulnerable Group Fund acknowledges that while health insurance can be contributory, it can also be non-contributory, where the government pays for the poor and vulnerable,” explained Dr. Ohiri.
The NHIA is also strengthening partnerships with state-run health insurance schemes, which is crucial for increasing enrollment nationwide. “Every state in Nigeria now has a state health insurance scheme, with Rivers State being the latest to join. Many states are also setting up Equity Funds to complement federal efforts,” Ohiri noted.
Despite these initiatives, the current health insurance coverage stands at only around 7 percent of the population, or 16 million Nigerians. However, the new NHIA Act aims to address this, making insurance mandatory and paving the way for universal coverage.
“With the act making insurance mandatory, we now have a pathway to universal coverage. We aim to increase the coverage significantly from the current 7 percent,” said Dr. Ohiri.
Achieving this ambitious goal will require a collaborative effort between the federal and state governments, the private sector, and civil society organizations. “Achieving universal healthcare coverage requires joint efforts from the federal and state governments, private sector, and civil society organizations,” Ohiri concluded.
These changes and initiatives by the NHIA are expected to strengthen Nigeria’s healthcare system and make health insurance more accessible to all citizens, particularly the most vulnerable groups.
