The Evaluation of the Effect of National Health Insurance Scheme in Enhancing Health Care Delivery
CHAPTER ONE
OBJECTIVE OF THE STUDY
The following are the objectives of the research work:
- To find out the significant contributions of effective and efficient national insurance scheme in Nigeria.
- To find out whether the government enhance easy accessibility of the national insurance in Enugu.
- To examine whether there is any awareness of the existence, roles, important benefits and workability of the business activities of national insurance scheme in Enugu.
- To find out the problems facing effective and efficient administration and management of national insurance scheme in Enugu.
CHAPTER TWO
REVIEW OF RELATED LITERATURE
INTRODUCTION
Introduction
Several approaches abound in financing healthcare. These range from fees for service to private insurance, general taxation, social insurance, community financing, loans and grants. In Nigeria, combinations of all these in different proportions have been practiced for decades. The most basic form of health care financing is that of fees for service, where a fee is charged to cover all or part of the cost of the service provided. In many low and middle income countries a fixed fee for service, known as a user charge, is used by government health facilities, both as a means of raising revenue and as a means of discouraging what may be viewed as ’unnecessary demand’. This form of health care financing has a number of disadvantages. The direct payment of fees for service is regressive in that it causes the greatest hardship for the poor, and may cause major difficulties in payment for waged labourers, who are unpaid during sickness (Goodman, 1993). The rising cost of health care services as well as the inability of the government health facilities to cope with the people’s demand necessitated the establishment of National Health Insurance Scheme (NHIS). The start of the NHIS dates back to 1962 when the need for health insurance in the provision of health care to Nigerians was first recognized (Akande and Bello, 2002; Katibi and Akande, 2003). It was fully approved by the Federal Government in 1997, signed into law in 1999 and launched officially on the 6th June 2005. The Scheme is designed to provide comprehensive health care delivery at affordable costs, covering employees of the formal sector, self employed, as well as rural communities, the poor and the vulnerable groups. The Nigerian health sector has largely been based on a fee for service system with government funds supplementing in capital project financing. External loans and grants in form of technical assistance and free drugs especially for preventive services are common in Nigeria. The Global fund for HIV/AIDS, Malaria and Tuberculosis is one of such initiatives. Immunization campaigns are also supported by donor agencies. So far, the common man is yet to get the best of healthcare in Nigeria. The fee for service system takes so much from his pockets and leaves him unprepared for most medical expenses. As a result of the possibility of very high and unpredictable medical costs, many users of the fee for service system arrange cover through private insurance schemes, where the risk of illness is pooled among the insured group. Private insurance schemes attempt to spread the risk of illness over all insurees and as such discriminate less against the sick than pure fee based systems (Green, 2007). Social insurance schemes on the other hand widen the base of private schemes with payments tied to wage levels. Contributions to the scheme are made by employees, employers, and in some cases the state. This system is identical for all enrolees, and the premiums are based on income rather than health status with collection systems for contributions organized within industrialized setting (Abel-Smith, 1992). In some countries social insurance systems have been the forerunners of national health systems through either national insurance or tax. The Nigerian government instituted a social health insurance system in 2005 to bring succour to the plight of its citizens through the National Health Insurance Scheme (NHIS).
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This chapter deals with the method used in collecting data required in carrying out this research work it explains the procedures that were followed and the instrument used in collecting data.
Sources of data collection
Data were collected from two main sources namely:
Primary source and Secondary source
Primary source:
These are materials of statistical investigation which were collected by the research for a particular purpose. They can be obtained through a survey, observation questionnaire or as experiment, the researcher has adopted the questionnaire method for this study.
Secondary source:
These are data from textbook Journal handset etc. they arise as by products of the same other purposes. Example administration, various other unpublished works and write ups were also used.
CHAPTER FOUR
PRESENTATION ANALYSIS INTERPRETATION OF DATA
Introduction
Efforts will be made at this stage to present, analyze and interpret the data collected during the field survey. This presentation will be based on the responses from the completed questionnaires. The result of this exercise will be summarized in tabular forms for easy references and analysis. It will also show answers to questions relating to the research questions for this research study. The researcher employed simple percentage in the analysis.
CHAPTER FIVE
SUMMARY CONCLUSION AND RECOMMENDATION
Introduction
It is important to ascertain that the objective of this study was to evaluate of the effect of health insurance scheme on healthcare delivery. In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in addressing the challenges health insurance scheme on healthcare delivery system
Summary
Haven successfully completed the study it is pertinent to state that the level of enrolment into the HIS is still very poor which inevitably contributes to the poor health status of Nigerians and the dismal health indices recorded in our health institutions. The level of dissatisfaction in the scheme is also a cause for concern that requires immediate attention from both the HMO’s and the healthcare providers. Sources of dissatisfaction included poor registration services, poor referral system, delays in receiving required services and unavailability of required service. The non coverage by the insurance scheme of some of the services required by enrolees is a policy issue which can only be dealt with at the level of policy formulation. Suffice to note that some enrolees (44%) will not mind increasing their contributions into the scheme in as much as these services would be covered in the benefit package.
Conclusion
Though Kwara State has made attempt at developing State Strategic Health Development Plan under the auspices of WHO. The present KWSSHP seeks to streamline and empower the SMOH and LGA health departments to reposition their organizational and management systems to provide the strategic and tactical leadership and governance for health. The KWSSHDP adopted priority areas of the NSHDP and developed state specific intervention areas taken into consideration various high impact services. The resource requirement for health was looked into with respect to Human, Physical/Material and Financial resources for health. It is addressed to bridge the gap observed in the state health sector. The financial plan aspect of KWSSHDP seek to close the financial gap in the state with adequately costed activities for the year operational plan and critically assessed available funds which is government budgetary provision, while exploring financial projections from the other sources like donor agencies and private sector. Implementation of the KWSSHDP is characterized by an adequately scheduled work plan which was derived from high impact activities list to accelerate the attainment of MDGs 4, 5 and 6. While some activities are planned for a year period, some are planned continuously for the period of the plan. A number of the activities are to be periodically executed. The training plan which also follows similar trends with work plan would take into priority practical exposure as part of training package, so as to bridge the gap between training and translation of acquired skills into practice for better performance. The procurement plan seeks to improve the effectiveness of procurement unit and develop an all encompassing procurement policy.
Recommendation
Haven successfully completed the study; the following recommendations are put forward by the researcher;
Removal of all bottlenecks encountered in the registration process in order to fast track registration of new and existing employees into the scheme Making policy statements to enable enrolment of self employed individuals and the immediate.
Creating an avenue where unemployed individuals can also access healthcare services at little or no cost even when they are not making contributions. The government can bear the cost incurred by the unemployed especially for those officially registered in a government certified unemployment register.
Compulsory enrolment into the scheme should be enforced for all working Nigerians starting with those working in government organizations. This will improve our dismal health indices as most Nigerians will then have access to better healthcare services without the encumbrance of large out of pocket expenses.
The researcher recommends that employers who are not willing to enrol their employees should be prosecuted.
Health Maintenance Organizations and healthcare providers must realize that enrolees have the right to choose who their service providers are and can change to another when not satisfied with services rendered. Therefore, it is recommended that every provider strive to provide the best of services and the monitoring agencies should step up their monitoring antennae in order to curb the menace of dissatisfaction which is fast becoming common place in the scheme.
Several Nigerians are not fully enlightened in the components and structure of the NHIS. The researcher recommends a massive and far reaching enlightenment campaign to educate the populace on the scheme, the benefits there in and the rights of an enrollee
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