Tuesday, 7 July 2015

The Need for National Health Insurance Scheme (NHIS).

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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