Why Lagos health insurance scheme is mandatory for residents, by Idris
What informed the mandatory health insurance scheme in the state?
Health insurance is a symbiotic financing scheme for the state; it is a way of mobilising funds for the sector. The sector is very huge and resource- demanding. So, if there is no financing scheme it would simply amount to a waste of time. This is because with a proper financing scheme, a number of things would be taken care of, one of which is access to healthcare. In the course of doing that, the quality of care and effectiveness of care would be addressed. If we get it right with the health insurance it would change the entire picture in the health sector because it will address the core issues.
Right now, practitioners in the public sector at the primary, secondary and tertiary care provider levels are not up to 400, while the private practitioners are over 4000. So, the focus is to effectively bring the two together for the benefit of the people. You also know that people have been bitterly complaining about waiting for too long at general hospitals, and some of them end up not being properly attended to or treated. What we are trying to do with this scheme is to reorder that system to address all the key problems. This is because all providers participating in the scheme must meet certain criteria if they must provide quality service. We should by now know that free healthcare cannot work, but there are poor people within our system and it is government’s responsibility to cater for them.
There are three goals that the government strives to achieve in the health sector in the state. The first is to reduce all the poor statistics that we have been recording. These include, high infant mortality rate, high maternal mortality rate, and so on. We are bent on improving these statistics for the better, so that less people die, less people fall ill.
The second one is what we call financial protection for the poor. It is the responsibility of government to take care of the poor, so they must be covered if not poverty will bring them ill health and the vicious cycle will continue. The third one is that even if you provide all the services and the people for whom the services are meant for are not happy, you have not succeeded. That is why the system must be responsive.
These are the three goals, but how do we do all that? This financing scheme is in a better position to address that since we can’t address everything because of the limitations we have. If we start with the basic things, essential services that could be taken care of at the primary healthcare level, at least 70 per cent of the problems would be addressed. That is why primary healthcare is the backbone of the health system.
Having said that, let me point it out that the health insurance scheme, unlike at the federal level, is mandatory for every Lagos resident by law. Everybody must contribute something.
For the poor, who cannot genuinely afford the cost of care, the state government will provide, that is why under that law, one per cent of the consolidated revenue of the state will go into that fund every year. If things go right at the national level, we also stand to benefit something in terms of contribution based on the National Health Act because local councils too will contribute. Philanthropists, who want to support can contribute. So, that pool of fund is to be managed by the agency set up by government to pay for services provided by accredited providers.
The contributors have a choice of who their providers would be. So, if you decide that your primary care provider should be a private person, as long as that provider is empanelled under the scheme, it is your choice. If you also want to choose a public facility, it is still your choice. If you are not happy with the provider, you are at liberty to make complaints to the agency, and if your complaints are genuine, you are free to change your provider. With the large pool of providers, you don’t necessarily have to start running across the state in order to attend a particular hospital, you can choose the provider that is nearest to you.
The same law also creates different plans under the scheme, but we are starting with the basic plan, which is about primary care. If there is a need to be referred by a facility because it cannot handle a case, then the person is referred to the next level of care, secondary care provider. A patient cannot go straight to a secondary care provider without that referral or else he will not be attended to. If he is attended to, then he would pay whatever amount that is charged. The idea is that every citizen’s health is supposed to be maintained, if we can do it in such a way that residents do not fall ill, then they would spend less. Waiting for a citizen to fall ill before going to the hospital would lead to paying more money than what is being contributed.
So, the basic plan covers the basic ailments like hypertension, diabetes, as well as maternal and child health. It also takes care of immunisation of children, antenatal care services for mothers, as well as Cesarean Section (CS) for a pregnant woman who requires such because it is one of the most common causes of maternal mortality.
How did you arrive at the premium to be paid?
We actually did an actuarial study, which said that N70, 000 should be the premium for a family of six, but government turned that down on the grounds that it would be too high. So, we reduced it to N40, 000 for a family of six. If 70 per cent of the people are covered in this basic care, all the negative health statistics will go down. The idea is to get people well; maintain wellness and not treat diseases.
Apart from this package, what are the others?
We have two other plans- private sector plan and the informal sector plan. There are people in the private sector who already have one plan or the other, but if you look at the totality of people covered, not more than five per cent of the residents are covered. The idea behind the Universal Health Coverage is to put as many people as possible under the insurance scheme.
However, to get things right, there are still so many things that are to be done, and this explains the reason why kicking off the scheme appears to be taking long. We have done studies to be sure the state government can fund this programme and sustain it. We are meeting with different providers to explain to them because just as the residents, they need to understand the policy. We are confident that as people get onboard and the experience is good, more people will enroll.
Why make the state’s health insurance scheme mandatory when some residents are already under the NHIS?
For those contributing to the NHIS, we are not going to force them to join us as it might create unnecessary problems out there. We are going to focus on the people who don’t have at all. And most of the people contributing are in the formal sector because it is easier to get their contribution.
How do you intend to take care of those in the informal sector, since they are not on salary?
The pay is flexible, but if an enrollee fails to contribute on time, it is going to affect other people. If you want to pay monthly or quarterly, there are provisions for that. We have to be reasonably sure that enrollees will pay or else they would be cheating other people. After breakdown, the entire amount went to as low as N500 per person per month. This is so because we do not want a situation where a person has to fall ill before visiting the health facility or paying his/her premium. Doing so would defeat the whole essence of the scheme.
What becomes of residents of rural and riverine communities, who do not have public and private healthcare facilities in their domain?
We have about 120 wards in the state with no public primary healthcare facilities at all. We also know that our budget can’t cover all those places because of many things we need to do. In those communities, there are private facilities and there is a payment scheme in the works, at least when they provide services to the people, the healthcare providers are sure of getting paid, which is what the insurance scheme is going to ensure.