Comparing the Nigeria National Health Insurance Scheme Act, 2004 and the National Health Insurance Authority Act, 2022 - What is New and its Implications for the Health System.

BACKGROUND: Currently, <10% of Nigerians are insured by the National Health Insurance Scheme (NHIS) and this among other things has led to the signing of the National Health Insurance Authority (NHIA) Act in May 2022, which aims at ensuring the effective implementation of a national health insurance policy and attainment of Universal Health Coverage (UHC) in Nigeria. OBJECTIVE: To highlight the new features of the NHIA Act and its policy implications for the Nigerian health system. METHODS: A modified Delphi method was used for extracting the differences in the two Acts. A total of three rounds of reviews were carried out among 5 reviewers within three weeks. Differences were tabulated and also presented in prose. FINDINGS: The NHIA Act makes health insurance mandatory for all residents of Nigeria with the introduction of the vulnerable group fund and implementation of the Basic Health Care Provision Fund through the established State Health Insurance Schemes. Unlike the NHIS which is a Scheme, the NHIA is an Authority and has an expanded function to regulate, promote, manage and integrate all health insurance schemes and practices in Nigeria. Also, funds management has been transferred from Health Maintenance Organizations to the State Health Insurance Schemes and the Health Maintenance Organizations are now excluded from the Governing Council. CONCLUSION: Certainly, the journey towards UHC could be safer and more equitable with health insurance now mandatory for all Nigerians and the introduction of vulnerable group funds in the new Act. This will eliminate the catastrophic expenses of poor Nigerians if the Act is correctly implemented.

CONTEXTE: Actuellement, moins de 10 % des Nigérians sont assurés par le régime national d'assurance maladie (NHIS), ce qui a conduit à la signature de la loi sur l'Autorité nationale d'assurance maladie (NHIA) en mai 2022, qui vise à assurer la mise en œuvre effective d'un régime national d'assurance maladie. politique d'assurance maladie et réalisation de la Couverture santé universelle au Nigeria. OBJECTIF: mettre en évidence les nouvelles caractéristiques de la loi NHIA et ses implications politiques pour le système de santé nigérian. METHODES: Une méthode Delphi modifiée a été utilisée pour extraire les différences entre les deux lois. Au total, trois séries d'examens ont été menées auprès de 5 examinateurs en trois semaines. Les différences ont été tabulées et également présentées en prose. RESULTATS: La loi NHIA rend l'assurance maladie obligatoire pour tous les résidents du Nigéria avec l'introduction du fonds pour les groupes vulnérables et la mise en œuvre du fonds de prestation de soins de santé de base par le biais des régimes d'assurance maladie établis par l'État. Contrairement au NHIS qui est un régime, le NHIA est une autorité et a une fonction élargie pour réglementer, promouvoir, gérer et intégrer tous les régimes et pratiques d'assurance maladie au Nigéria. En outre, la gestion financière a été transférée des organismes de gestion de la santé aux régimes publics d'assurance maladie, les organismes de gestion de la santé étant exclus du conseil d'administration. CONCLUSION: Certes, le parcours vers la CSU pourrait être plus sûr et plus équitable avec une assurance maladie désormais obligatoire pour tous les Nigérians et l'introduction de fonds pour les groupes vulnérables dans la nouvelle loi. Cela éliminera les dépenses catastrophiques des Nigérians pauvres si la loi est correctement mise en œuvre. Mots-clés: Assurance maladie, système de santé, NHIA, NHIS, Nigeria.

Assessment of Willingness to pay for Community-Based Health Insurance among Artisans in a selected Community of Ekiti State, Southwest Nigeria

Background: Community-based health insurance (CBHI) has emerged as a more efficient and equitable approach to healthcare financing. It was designed to ensure that sufficient resources are made available for members to access effective healthcare. This study assessed the willingness to pay (WTP) for CBHI among artisans in a town in Ekiti State, South West Nigeria. Methods: This was a cross-sectional survey conducted among 416 artisans in a town in Ekiti State. A semi-structured interviewer-administered questionnaire was designed and used for data collection on sociodemographic data and WTP for CBHIS. Data entry and analysis was done using IBM SPSS software version 25.0. Results: The mean age and standard deviation of the respondents was 29.7±10.9 years with male to female ratio of 1:1.4. Most of the respondents were willing to pay (86.3%) and willing to enroll other household members (73.6%) in the CBHI. A large percentage (44.3%) of those willing to pay were ready to pay between ₦1,000-₦5,000 (US$2.63­US$13.16) per year while 39.6% preferred frequency of payment to be annually. Positive predictors of WTP for CBHI were age groups ≥50 years and 40-49 years than <20 years (AOR:13.270, 95%CI: 1.597-110.267; AOR:142.996, 95%CI: 10.689-1913.009). Females than males (AOR:9.155, 95%CI: 3.680-22.775), tertiary level of education than no formal of education (AOR:23.420, 95%CI: 1.648-850.921), no children than ≥5 children (AOR:20.099, 95%CI: 2.705-149.364), earn ≥₦30,000 (US$78.95) than <₦30,000 (AOR:2.248, 95%CI: 1.278-6.499). often and somethings fall ill than seldom fall ill (AOR:6.505, 95%CI: 1.623-26.065; AOR:4.889, 95%CI: 1.674-14.279) Conclusion: WTP for CBHI was high among the artisans, however, there is a variation across the amount and frequency of payment. Therefore, policy that is flexible enough to allow artisans enroll and pay a premium that is affordable, at an acceptable frequency, should be formulated by the Government.