Medical professionals argue that the current health insurance rates in Nigeria are insufficient and have urged for an increase to better align with the country’s challenging economic conditions.
The physicians pointed out that prior to the last minor adjustment in May 2024, they had been utilizing rates that were negotiated 12 years ago, despite notable rises in associated expenses over that time.
They indicated that the recent slight increase is intended as a stopgap until the results of governmental actuarial assessments, set to take place in September, are available.
These actuarial assessments are anticipated to establish the appropriate costs for insurance services in Nigeria.
The outcomes of these studies are expected to facilitate discussions among stakeholders in health insurance and healthcare providers for further negotiations.
It is worth noting that the Association of Nigeria Private Medical Practitioners recently warned of a potential withdrawal from the National Health Insurance Scheme (NHIS), a decision that could impact over 16 million beneficiaries of the program.
The association set a deadline indicating that they would cease providing services to NHIS beneficiaries by August if the National Health Insurance Authority (NHIA) does not revise the tariff, which has been fixed at N750 for the last 12 years.
They voiced their frustration that, after a decade of inflation burdening hospital finances, the government has failed to respond to requests for an increase in tariffs that reflects the escalating costs of goods and services.
Experts have indicated that health insurance pricing in Nigeria, especially among state governments, remains excessively low.
They pointed out that energy expenses are a major contributor, comprising over 40 percent of total hospital operating costs in Nigeria.
According to Dr. Austin Aipoh, the President of the Association of Nigeria Private Medical Practitioners, recent gatherings of stakeholders in insurance and healthcare providers have resulted in an agreement on a new tariff structure for medical services and supplies.
Aipoh highlighted that during a meeting in Abuja, they resolved to implement a 60 percent rise in capitation rates and a 40 percent increase in Fee-For-Service charges.
While acknowledging that this adjustment is still inadequate, the service providers chose to accept the minimal increase temporarily while awaiting the results of the actuarial studies.
He clarified that capitation and Fee-For-Service are payment methods utilized by the NHIA to compensate healthcare providers for services offered to beneficiaries.
Aipoh stated, “It has been challenging. Imagine that we are still using the tariff we negotiated in 2012 to treat NHIS patients in 2024. Between June and July, healthcare providers and the insurance authorities met in Abuja to review the health insurance system and develop a new tariff structure.
“The last tariff adjustment was made in 2012, 12 years ago. Considering the rate of inflation over this period, the previous tariff was outdated. We agreed on a minimal increase as a temporary measure until the actuarial studies are completed.
“This minimal increase is set to last for three months, ending in September, at which point we will revisit the tariff based on the actuarial findings. So, we are currently awaiting the results.
“We raised the capitation from N750 to N1,200. For Fee-For-Service, we implemented a 40 percent increase. While this adjustment is insufficient, it was agreed upon as a temporary measure to allow the government to complete the studies and provide further guidance.
“We trust that the government will uphold its commitment. After addressing the tariff issue at the national level, we will focus on the state-level schemes, which are still significantly underfunded.
“For example, Lagos State is paying just N400 per patient per month. Many patients report subpar services at hospitals, which is a direct result of this low funding. If a large number of patients require treatment, such as for malaria, healthcare providers will face considerable challenges. We are hopeful that the government will honour its agreement.”
Dr. Babatunde Rosiji, Medical Director of the State Specialist Hospital in Ikole, Ekiti State, cited several challenges that may lead private doctors to stop treating insured patients until a resolution is reached through an emergency meeting and negotiations.
Rosiji said, “For example, if I purchase a drug for N1 in the market and treat an NHIS patient, the cost of the drugs is effectively reduced by a factor of five. This discrepancy makes it difficult to cover other expenses, especially with the soaring electricity tariffs that are beyond the reach of many Nigerians.
“The agreed premiums and Fee-for-Service rates need to be renegotiated to reflect current economic realities. These adjustments ensure that NHIS patients receive quality care and are not relegated to second-class treatment in our hospitals.
