Economic and Financial burden of health insurance in Nigeria: preference to the elderly?

Health insurance is a pool of resources to cater for the health needs of people, with the intent of making the cost of health care affordable and less burdensome for the average member of society. Thus, it involves a contribution from the payer, the healthcare provider, and the beneficiaries.

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The health of a nation influences the wealth of that nation, thus underscoring the significance of paying attention to the health of the nation. Nigeria is yet to achieve Universal Health Coverage (UCH); however, it has recently repealed the National Health Insurance Scheme (NHIS) Act to become the National Health Insurance Authority (NHIA) in May 2022, with the mandate to ensure all Nigerians have financial access to quality healthcare services buttressed by its mandatory health insurance. The implication is that all citizens and legal residents of Nigeria must, as a compulsion, have their health insured. This is a commendable step towards achieving UHC.

The NHIA has continued to enroll federal civil servants and their families (a spouse and a maximum of four biological children) over the years through an employer-employee payment ratio, which has not been implemented but has used medical allowances to foot the bills of the enrollees of the health insurance. NHIA has also facilitated state social health insurance agencies as a body to facilitate health insurance coverage at the state level, employing the Basic Health Insurance Funds from the Federal Government to ensure the vulnerable (children less than five years old, pregnant women, indigents, and very elderly people) have free access to healthcare services, especially in rural areas. This has its own challenges, such as the unavailability of drugs and medical professionals, especially at the primary healthcare centers.

PRIVATE HEALTH INSURANCE (PHI)
It is common knowledge to have expenses subsidized by the government; however, for private individuals or organizations, payment is usually full. For private organizations, their health is insured through surcharges on their pay, which are easy to deduct irrespective of whether they are willing or not.

For private individuals, retirees, market sellers, etc., the reverse is the case, as it involves an annual and renewable fee. Currently, the minimum annual payment to have access to the benefits of health insurance in Nigeria is N45,000 ($60) for a maximum of three people in a country where the minimum wage is N30,000 ($40). This annual payment of N45,000 is only for a year and must be renewed. For a family of four (father, mother, and two children), the health insurance fee is N60,000 ($80) per annum. For a group of ten people, for example, it will cost N150,000 ($200) per year. A reasonable number of people who opt for this voluntary health insurance are those who have major medical illnesses and are seeking ways to enjoy cheaper access to healthcare. Now, the question is, "How cheap is health insurance in Nigeria, and who are those that require it more?

Unfortunately, the retirees are not covered under health insurance except for some formal sectors, such as the Nigerian Police Force (NPF), which has made provision for their retirees. My mom is a retired nurse, and her name was struck out of health insurance coverage immediately after she retired. The system automatically removes every retiree at the age of sixty or every child that has reached the age of eighteen. Well, I have been paying N15000 ($20) per annum for my mom’s health insurance even though she rarely uses it as she enjoys the benefit of having her son as a doctor.

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The average civil servant in Nigeria earns between N30,000 ($40) and N600,00 ($800) per month, which is dependent on grade level and qualification. With a population above two hundred million people in Nigeria, about two-thirds live on less than N1500 ($2) per day. This indicates a huge poverty burden on its citizens, bearing in mind their low income.
Recently, a colleague of mine lamented how he spent N13,000 ($13) over the weekend on the health challenges of his daughter. This was a one-time hospital visit, which is an indicator of the probable cost of healthcare for the average Nigerian. For most hospitals, the average cost of accessing health care would range between N5,000 ($6.7) and N15,000 ($20). Permit me to attempt a breakdown analysis.

Opening of Hospital Folder = N2000-NN10,000 ($2.7-$13.3)
Consultation: N2,000–N15,000 ($2.7–$20)
Drugs (depending on the ailment) = N2,000–N15,000 ($2.7–$20)
Admissions require a minimum deposit of N15,000 ($20), which does not guarantee the total cost of treatment.

The above analysis would thus indicate a wise decision to have health insurance coverage for a minimum annual payment of N45,000 ($60) with the capacity to accommodate three people.

WHO NEEDS THE HEALTH INSURANCE MORE?
Nobody wants to pay more when a commodity or service can be obtained for a cheaper amount. Medical illnesses are usually more common among the elderly, mostly as a result of age and other factors such as reduced mobility, poor detection of medical illnesses, etc.

The elderly are considered to have less need for money (I may choose to disagree), despite the meager amount received as pensions. Some retirees still battle with house rent and children’s tuition. And probably those in active service may be able to afford medical bills even when health insurance is not available. Let me ask your honest opinion: who do you think should benefit more from health insurance? Those active in service or those retired? I'd love to stick with the latter. Everyone deserves health insurance, but by preference of occurrence of disease conditions and affordability, I would stick with the elderly (even though their level of productivity to society has diminished).

Thank you for reading. I would love to have your comments and contributions.

NHIA