Health Insurance: principles, models and the Nigerian National Health Insurance Scheme

Abstract

Introduction: 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. This article amongst other things outlines the principles and models of health insurance and then examines the equity implications of the NHIS.
Methods: A literature review of the principles and models of health insurance and a critical examination of the National Health Insurance Scheme and Community Based Health Insurance (CBHI) were carried out. Grey literature (conference papers, technical reports, dissertations, etc), journal articles, abstracts, relevant books and internet articles were reviewed.The review covered the period 1986 to 2010. The search words used were insurance, health insurance, health insurance models, principles of health insurance, market failure, community based health insurance, Nigerian national health insurance scheme.
Results: There are many forms of insurance schemes ranging from Social (compulsory) health insurance to Private (voluntary) health insurance, and both have many different sub-versions. In addition, they all have different modes of operation. These models of health insurance as well as the strengths, weaknesses, opportunities and threats of the NHIS and CBHI are outlined.                                                                          Conclusion: For any social health insurance scheme to offer full coverage of its citizens the government should not focus on only one type of health insurance scheme. A comprehensive benefit package is needed and the disconnect between the three tiers of government should be addressed. The different tiers of government should be encouraged to buy into the scheme and avenues for funding through general taxation, donor financing etc should be explored in Nigeria.

Key words: Health insurance, Health insurance models, market failure, Nigerian Health Insurance Scheme, Community Based Health Insurance.