By Jimoh Babatunde

Nearly four years after former President Muhammadu Buhari signed the National Health Insurance Authority Act into law, Nigeria’s healthcare financing system is beginning to show measurable momentum.

Health insurance enrolment has more than doubled since 2022, the Basic Health Care Provision Fund has expanded vulnerable-group coverage, and recent reforms to provider payments have attempted to address longstanding complaints around reimbursement and service delivery.

But even as policymakers focus on expanding coverage, healthcare strategist Lucky Ilodigwe believes the country must begin preparing for another challenge already emerging quietly across hospitals and clinics: elderly care.

In an interview with Vanguard, Lucky Ilodigwe, whose career spans PwC Nigeria, Boston Consulting Group and now Humana in the United States, said Nigeria has an opportunity to learn selectively from America’s Medicare system while avoiding many of its costly mistakes.

Nigeria is often described as a young country. Why do you posit that elderly care already be a major policy conversation?

Ilodigwe: Precisely because we are young.

Nigeria’s over-60 population is projected to triple by 2050. That means millions of Nigerians who are currently middle-aged will enter old age within a system that still lacks a defined elderly-care architecture.

The reality is that our hospitals are already seeing the transition. Facilities like Lagos University Teaching Hospital and University College Hospital are managing increasing cases of hypertension, diabetes, stroke, chronic kidney disease and dementia.

These are not conditions solved by one hospital admission. They require coordinated care over years, sometimes decades.

Your current work focuses on Medicare Advantage in the United States. What lessons from that system are actually relevant to Nigeria?

Ilodigwe: The most important lesson is that elderly care must be designed as a financing system, not treated as an afterthought.

One of the strongest features of Medicare Advantage is capitation. Insurers receive a fixed amount per member, which changes incentives completely. Instead of waiting for illness, the system rewards prevention, continuity and coordinated care.

At Humana, we invest heavily in home visits, medication management and post-discharge support because preventing complications reduces costs and improves outcomes simultaneously.

Nigeria’s reforms under the NHIA, especially the increase in capitation rates, are positive steps. But increasing tariffs alone is not enough. The payment structure itself has to reward proactive care.

What specific mechanisms from America’s system do you think Nigeria should seriously study?

Ilodigwe: The quality-rating model is one.

In the United States, Medicare Advantage plans are publicly rated using measurable indicators like diabetes control, medication adherence and patient experience. Plans with stronger performance receive financial bonuses.

That creates a real incentive to improve care quality.

Nigeria’s current accreditation process is still mostly binary. A transparent quality scorecard tied to modest financial incentives could significantly improve behaviour across HMOs and providers.

Another important lesson is segmentation.

Older adults are not one uniform population. Someone managing hypertension independently at 65 has completely different needs from someone living with dementia at 82. The system has to recognise those differences structurally.

America’s healthcare system is also heavily criticised within and outside the region. What should Nigeria avoid copying?

Ilodigwe: Complexity.

The American system became so administratively complicated that many elderly people now require brokers just to navigate plan options. That is not a direction Nigeria should follow.

We should prioritise simplicity in benefit design, automatic enrolment where possible and clear cost-sharing structures.

The second caution is long-term care financing. Medicare does not fully cover prolonged nursing-home care, which means many American families exhaust their savings before qualifying for support.

Nigeria should not wait until demographic pressures intensify before designing a sustainable long-term care strategy.

You mentioned that Nigeria still has an opportunity to design differently. What would a practical elderly-care agenda look like?

Ilodigwe: First, NHIA should define Nigerians aged 60 and above as a dedicated enrolment category with a benefit package specifically designed around chronic disease management.

Second, Nigeria should pilot capitated elderly-care programmes with selected HMOs and state insurance agencies.

Third, we need public quality reporting.

Fourth, we should invest in community-based elderly-care models rather than depending entirely on institutional nursing homes. Programmes similar to America’s PACE model could work well in urban communities where families still want elders cared for close to home.

And finally, workforce development is critical. Nigeria currently has extremely limited geriatric specialist capacity relative to population size.

Are there any signs that we are in the right direction just yet?

Ilodigwe: The fact that reform momentum already exists.

The NHIA Act created an important foundation. Coverage is expanding. The BHCPF reforms showed that vulnerable-group financing can scale operationally. There is clearly more policy seriousness around health insurance now than existed a decade ago.

Nigeria still has the advantage of designing early.

Countries that struggle most with ageing are usually those that delayed preparation until demographic pressure became overwhelming. Nigeria still has time to build deliberately and intelligently.

Any final thoughts?

Ilodigwe: We do not need to replicate America.

But we should study carefully what worked, especially around financing, accountability and chronic disease management, while avoiding the inefficiencies and fragmentation that made parts of the U.S. system so expensive.

Nigeria is at a genuine design moment in healthcare. The decisions made over the next decade will shape how tens of millions of older Nigerians experience ageing, illness and dignity in the decades ahead.