The establishment of the scheme was
informed by the following factors:
v The
general poor state of the Nation’s healthcare services.
v The
excessive dependence and pressure on government provided health facilities.
v Dwindling
funding of healthcare in the face of rising costs.
v Poor
integration of private health facilities in the Nation’s healthcare delivery
system.
1.1.6.
The Objectives of the Scheme
The objectives of National Health Insurance
Scheme (NHIS) are:
· To
ensure that every Nigerian has access to good healthcare services.
· To
protect families from the financial hardship of huge medical bills.
· To
limit the rise in the cost of healthcare services.
· To
ensure equitable distribution of healthcare costs among different income groups.
· To
ensure high standard of healthcare services delivery to Nigerians.
· To
ensure efficiency in healthcare services
· To
improve and harness private sector participation in the provision of healthcare
services.
· To
ensure equitable distribution of health facilities within the federation
· To
ensure appropriate patronage of all levels of healthcare.
· To
ensure the availability of funds to the health sector for improved services.
1.1.7.
Classification of NHIS Programmes
In order to ensure that every Nigerian
has access to good healthcare services, the National Health Insurance Scheme has
developed various cover for different segments of the society. These are:
v Formal sector programme:
· Public
sector (Federal, State, Local Government)
· Armed
forces, Police and other Uniformed services.
· Organized
private sector
· Students
of Tertiary Institutions and Voluntary participations
v Informal Sector:
· Rural
Community
· Urban
self employed
v Vulnerable group:
· Permanently
disabled persons and the Aged
·
Children under five
·
Prison inmates
v Others:
·
Diaspora family and friends
·
International Travel Health Insurance
·
Pregnant women and orphans
· Retired
& unemployed
1.1.8. Formal Sector Social Health
Insurance Programme
This
programme covers employees of the formed sector that is the public and the organized
private sectors. It is mandatory for every organization with (10) or more employees.
Benefit
Package (Services Covered)
v Primary
Healthcare services
· Access
to curative services for common ailments, including consumables and outpatient care.
· Essential
drugs from NHIS accredited pharmacy provider plus needed provision of pharmaceutical
care by the pharmacists. Beneficiary is expected to pay 10% of the total cost
of drugs (co-payment)
· Routine
laboratory investigations
· Health
education to prevent and control health problems such as counseling and testing
for HIV/AIDS, plus health education
· Maternal
and childcare services
· Primary
eye care, dental and mental services.
· Accident
and emergency services.
v Secondary Health Care Services.
· Specialists
care for medical, surgical, pediatrica, obsteris and gynecology, internal medicine,
psychiatry, ENT, ophthalmology, management of HIV/AIDS etc.
· Hospitalization
in general wards, maximum of 15 days per year.
· Physiotherapy-restorative
and rehabilitative services.
· Radiology/Medical
imaging and diagnostic laboratory services.
· All
prescribed pharmaceuticals from Federal Ministry of Health (FMOH).
v Tertiary
Health Care Services
All referrals from
Primary and secondary Health Services
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