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Mixed blessings of a voluntary health insurance scheme

By Sola Ogundipe

SINCE it was established under Act 35 of 1999 by the Federal Government, the primary aim of the National Health Insurance Scheme, NHIS, has been to provide easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.

Under the formal sector programme of the Scheme, an employee pays contributions to cover individual healthcare benefits, in addition to a spouse and four biological children below 18 years of age.

Provided under this plan is a benefit package, including out-patient care, drugs, pharmaceutical care and diagnostic tests. Other benefits are maternity care for up to four live births, preventive care, including immunisation, health education, family planning, and consultation with specialists, etc.

From hindsight, one of the major expectations of the National Health Insurance Scheme, NHIS, as mapped out under the O, Functions and Powers, is to ensure that every Nigerian has access to good health care services, while being protected from the financial hardship of huge medical bills and assured of equitable distribution of health care costs, irrespective of income or social status.

Financing challenges
But considering its current limitations and financing challenges, it is debatable whether the formal sector scheme has met expectations of Nigerians in attaining and securing universal coverage and access to adequate and affordable healthcare. Nigerians, especially those who are self-employed or in the informal sector, have consistently agitated for a credible policy option that would offer affordable health care plans.

Enter the Voluntary
Contribution Social Health Insurance Programme – VCSHIP. Under this plan, with N15, 000 an individual can access basic health care for 12 calendar months after registration and payment and there are registered 13 Health Maintenance Organisations, HMOs, to choose from.

Since it made its debut earlier in the year, the VCSHIP, has left no one in doubt that it is a health insurance plan specifically focused on  voluntary individuals, and societies in the informal (and formal) sectors in the country.  The plan is already widely acknowledged as a step in the long march towards improved financial protection against the cost of illness in Nigeria.

Presenting the VCSHIP at a media forum in Lagos recently, NHIS Executive Secretary, Dr. Abdulrahman Sambo, described it as a credible policy option for financing healthcare, especially at low income levels.

Sambo, who is quite optimistic about the VCSHIP set up, told Vanguard Features, VF, that it is specifically designed for Nigerians not currently under coverage of any of the existing individuals or employers on behalf of their employees in organisations with less than 10 staff.

“It is a means of ensuring expanded coverage, especially for the self-employed and those working in organisations with staff less than 10 with no formal health services provision for staff and their dependants.”

The target group is definite. “Membership is for willing individuals, employers on behalf of their employees in organisation of less than 10 staff. Other beneficiaries include political office holders, retirees not covered by other NHIS programmes, foreigners to Nigeria or persons with temporary residency,” Sambo said.

The scope of coverage is also straightforward. “An individual can benefit in the case of individual contribution, while an employer with less than 10 staff also qualifies.”

So now, how is this plan financed? VF gathered that this health insurance scheme is financed directly from contributions made by increased individuals at a contribution rate actually determined at N15,000 per enrollee annually.

“Enrolees buy vouchers from designated outlets (HMO offices, health care facilities or banks), register and select health care providers while ensuring registration is concluded with data capture. They also pay 10 per cent co-payment for drugs supplied.”

A beauty of the VCSHIP is that it is completely accessible online. Potential enrollees only need to obtain a N500 scratch card, access the website, register and pay the N15, 000 contribution fee. Online registration is plain easy.

On purchase of a voucher from a participating HMO, an intending contributor opens to the NHIS website at www.nhis.gov.ng and clicks on the voluntary contributors’ link on the right hand side of the home web page.

According to the setup, health care facilities/health organisations acquire data capturing machines and vouchers from the scheme. The healthcare facilities/HMOs sell the vouchers to prospective enrollees who then register on-line by logging on to the NHIS web site.

A NHIS number would be allotted to enrollee when registration is concluded. Then the enrollee visits the selected HMO or preferred health facility for data capturing, following which identity cards are issued by the HMOs through health care facilities.

Next, the enrollee may proceed to access to healthcare at the chosen health facility and pharmacies after a month from when registration is completed, provided an acknowledgement slip and VCSHIP identity card have been obtained.

Prepaid voucher
The registration is renewable a month before expiration of the current package following an automatic SMS alert. Further details are obtainable from vcship@nhis.gov.ng .

Exiting is as easy as entering. The prepaid voucher entitles a beneficiary to health care services for one year. An enrollee can exit from the programme any time by notifying the HMO, who shall notify the primary provider to terminate access as at when due.

In the event of re-arrangement, a waiting period of two months is observed.

With a benefit package comparable to the standard NHIS package, the VSHIP programme offers real value-for-money.

According to Sambo, the healthcare system is geared towards providing all the services in one place – drugs, laboratory tests inclusive.

The prospects of the VCSHIP are only just evolving, in Nigeria. Already, there are indications of high demand. And this is not surprising.

With provision for access to affordable, cost effective and equitable healthcare, the move to universal coverage by 2015 and improving life expectancy of Nigerians may be closer than anticipated.


Disclaimer

Comments expressed here do not reflect the opinions of vanguard newspapers or any employee thereof.