Nigeria's Health Insurance Authority Ups Hospital Payments by 373%

In a decisive move aimed at bolstering service quality and rebuilding public trust within Nigeria's health insurance ecosystem, the National Health Insurance Authority (NHIA) has announced a substantial 373 per cent hike in reimbursements for healthcare providers operating under its fee-for-service model. Dr. Kelechi Ohiri, the Director-General of the NHIA, revealed this significant development on Thursday during a collaborative quarterly press briefing, jointly hosted by the NHIA and the National Primary Health Care Development Agency.

Dr. Ohiri explained that this increment was a direct consequence of an extensive actuarial assessment of the current healthcare tariffs. These tariffs, he noted, had remained unchanged for a full decade, failing to account for the escalating costs of pharmaceuticals and medical services over that period. Furthermore, the comprehensive review led to a twofold increase in capitation payments to healthcare providers. The newly adjusted tariffs, crafted to mirror current market prices, are set to become effective on April 1, 2025. Their primary objective, as stated by the Director-General, is to guarantee that healthcare institutions receive fair compensation for the services they render to individuals enrolled in health insurance schemes.

Ohiri explicitly stated, "We launched an actuarial review of the existing tariffs. These had not been increased or revised in a decade, and we know that the cost of medicines has been increasing. What we did was to review them using the same principles, which resulted in a doubling of what is paid for in capitation and a 373 per cent increase in what was reimbursed in terms of fee for service."

The NHIA's head underscored the critical role of sufficient reimbursement in elevating the standard of healthcare. He highlighted ongoing concerns from patients who reported being refused services covered by their insurance policies or being compelled to pay cash for medications and procedures. To tackle these persistent issues, the authority has rolled out several new initiatives, including a crucial directive mandating hospitals to initiate patient treatment even if authorisation codes are not provided within a one-hour timeframe.

Furthermore, Dr. Ohiri mentioned that the NHIA has significantly reinforced its system for resolving complaints, achieving a resolution rate of approximately 87 per cent for grievances lodged in the previous year, all within a 48-hour window. He also confirmed that the authority has implemented penalties where inappropriate charges were identified, which includes compelling refunds to enrollees who had paid for services already covered by their insurance plans. Additional punitive actions encompass the removal of healthcare facilities from the NHIA network and penalizing defaulting health maintenance organisations (HMOs).

To further assist enrollees, the Director-General revealed the deployment of NHIA staff to nineteen high-traffic healthcare centres across the Federal Capital Territory. Their role is to facilitate the resolution of complaints and mitigate difficulties faced by insured individuals. These interventions, he elaborated, form part of a wider strategy designed to restore public confidence and guarantee that expanded insurance enrolment genuinely leads to improved healthcare encounters for Nigerians.

In a related development, Ohiri also shared that the national health insurance coverage has seen a remarkable 42 per cent growth, escalating from roughly 16 million people in January 2024 to an impressive 23.02 million. He further highlighted that a substantial 3.18 million impoverished and vulnerable citizens are currently accessing government-sponsored health insurance through the Basic Health Care Provision Fund.

The NHIA chief affirmed the authority’s ongoing commitment to collaborating with various stakeholders, including healthcare service providers, governmental bodies, media outlets, and civil society organisations. This collaborative approach aims to enhance accountability, broaden the reach of health insurance, and ultimately improve access to high-quality healthcare services nationwide.

The National Health Insurance Authority Act, enacted in 2022, laid down the groundwork for compulsory health insurance for all residents and intensified initiatives to broaden avenues for healthcare funding. Nevertheless, the high cost of medical care and the prevalent practice of out-of-pocket payments continue to pose considerable hurdles for Nigerian families seeking medical attention. The recent tariff review and subsequent adjustments to reimbursements by the NHIA are designed to bolster the financial viability of healthcare providers engaged in insurance programs, thereby facilitating the provision of services outlined in enrollees’ benefit packages. Ultimately, consistent and sufficient reimbursement, coupled with robust oversight and adherence from healthcare providers, is paramount to ensuring that health insurance truly delivers accessible and high-quality care to the populace.