Health plans Nigeria
Health Insurance Fund has been active with health plans in Nigeria since 2007. With our local partner Hygeia Community Health Care, the largest healthcare services group in the country, and our implementing partner the PharmAccess Group, we support health plans targeting market traders and company employees in Lagos and rural communities in Kwara State.
Kwara Community Health Insurance Program
This health plan targeting farmers and their dependents, launched in 2007, was the first program in Health Insurance Fund's health plans portfolio. It started in North Kwara, expanded to Kwara Central in 2009 and to Kwara South in 2012. In that year, the Kwara State Government adopted the Community Health Insurance Bill, which prioritizes health care for low-income people through community-based health plans.
During a milestone event in 2014, it confirmed this priority with the launch of the scale up of the Community Health Insurance Program, pledging access to affordable quality health care for at least 60% of the population by 2018. It has committed to taking over the financial responsibility for the program, reserving 34 million euro to improve 50 primary health care centers across the state every year, to pay for the premium subsidies and to scale up the health insurance program to 600,000 low-income people.
Health plans in Lagos
The first health plan in Lagos, targeting Lagos Market Women, launched in 2007. Two years later, the program was extended to low- and middle-income members (and their dependents) of small businesses in the Computer and Allied Products Dealers Association Nigeria (CAPDAN) under an agreement that was signed with the World Bank and GPOBA in October 2008.
Access to care has dramatically increased, delivery related visits consistently exceeded the targets, renewal rates in the CAPDAN scheme were as high as 77% and the quality of care at both public and private providers in the network has improved considerably over the years.
Despite these successes, important lessons were learnt from running such a health insurance scheme in a densely populated urban setting where majority of the residents are considered poor. The challenges included:
- over-utilization; the utilization rates were high which resulted in high medical costs.
- claims ratio of >100%; the premium was not sufficient to cover the medical cost.
- adverse selection; many chronically ill patients and pregnant women enrolled into the schemes resulting in an unhealthy risk pool
- excess costs were incurred for administration and marketing
- fraudulent practices such as impersonation amongst enrollees and enrollment of ineligible enrollees.
These lessons were taken into account during the design of a new health plan for the target population: Hygeia Better Life, which is deemed to be a more sustainable alternative.
Since 2014, PharmAccess supports a community-based health insurance program in Ogun State, Nigeria, in a consortium that includes the African Health Markets for Equity (AHME) program.
Local executing partner
Hygeia is the largest Health Maintenance Organization (HMO) in Nigeria, with a network of over 200 clinics and hospitals throughout Nigeria and around 200,000 paying members. Hygeia has over 20 years of experience in health care in Nigeria and is one of the HMOs executing Nigeria’s new National Health Insurance Scheme (NHIS). We selected Hygeia as local implementing partner based on a medical, administrative and financial assessment process, including a due diligence carried out by PricewaterhouseCoopers.
|Models||Kwara||Lagos (Lagos Market Women/CAPDAN)||Lagos (Hygeia Better Life)|
|Design||Community-based voluntary||Voluntary individual enrolment||Voluntary family enrolment|
|Benefits||Primary care (OP), Maternity, Chronic disease care and minor surgeries||Primary care (OP), Maternity, Chronic disease care and minor surgeries||Primary care: Basic Care (OP)
-Inpatient max 2 days pppa
-1 case of Pregnancy & Delivery
-Chronic care (no referrals, no specialist care)
-Emergency care-Inpatient for maternity: max 15 days
|Provider network||Mix of public, private & faith-based providers||Mix of public, private & faith-based providers||Mix of public, private & faith-based providers|