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THE ROLE OF INSURANCE SCHEME IN HEALTH SERVICES IN NIGERIA

ABSTRACT

In Nigeria, the insurance scheme health services have played a significant role in enhancing health services.

The purpose of this study was to look into the issues, abuses, and effects of health insurance schemes.

This organization’s principal goal is to ensure that all of its residents have access to high-quality medical care. In addition, all residents in need of medical treatment, regardless of class or status, race, age, or sex, will have access to it.

Finally, to ensure that decent health services are available to both the poor and the wealthy through the payment of a premium. In addition, the majority of the population is able to obtain medical treatments from a designated health care facility without difficulty.

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

It is said that one’s health is the most significant aspect of one’s existence. But, before I go into the measures that the Nigerian government will take to implement a health insurance plan, it’s important to understand what the federal government and certain state governments have done in the field of health insurance for the country and some states.

On August 23rd, 1985, Nigeria’s Minister of Health, Chief (Dr) Emmanuel Nsan, established a special advisory committee on the National Health Insurance Scheme to investigate issues related to health insurance schemes as a way of financing personal health care services. The following were the committee’s terms of reference:

1. Determine the viability of Nigeria’s National Health Insurance Scheme.

2. To provide advice on the logistics of putting such a system in place.

3. To investigate any other topic that the committee deems to be important to the functioning of a viable health insurance plan in Nigeria.

4. Making recommendations

STATEMENT OF PROBLEM

The scheme’s customary problems are numerous, and in our society, they will be considerably more numerous; some of these problems include:

1. The hospital’s level of authenticity in billing. Hospitals are notorious for sending outrageous bills or colluding with scheme participants. If a predetermined quantity is set for each form of disease, the problem will be solved.

2. Billing settlements when cases are referred to hospitals outside the organization.

In many situations, patients are referred to hospitals that are not part of the group, making it difficult to collect their costs because they are not obligated by the same standards as the group’s institutions. These hospitals should be forced to follow the rules.

4. Statistics and records are lacking.

Unfortunately, most of our hospitals do not have information on the number of people that visit them or the kind of ailments or illnesses for which they are treated. There are no statistics on relapses or recurrences of these conditions, either. This workshop, in my opinion, should seriously consider the issue of maintaining statistics of those who visit hospitals and the illnesses for which they are treated, and making this information available to anyone so that both doctors who set premiums and insurance companies can determine the basis of their rating.

PURPOSE OF THE STUDY

The goal of this study is to assess the role and strength of the insurance scheme in Nigerian health care.

1. To give recommendations on operational modes and other matters that may be regarded significant to the scheme’s setup.

2. To look into the policy implementation, planning arrangements, and any current or potential administrative structure that may be needed to get the program up and running on schedule.

3. Examine the scheme’s implementation phase and provide recommendations on a timeline for implementation.

4. To investigate, in light of past research on the subject, the formation of a health insurance program as a means of paying health care services in Nigeria.

SIGNIFICANCE OF THE STUDY

The committee enumerated the well-known advantages that such a program will provide. These are the following:

1. The proposed program shall provide basic primary health care, as well as some components of secondary and tertiary health care, to eligible beneficiaries of the services at no additional cost.

 

2. Primary health care, including child immunization, nutrition oral dehydration therapy, family planning services, subsidized family planning devices, health education, consultation, diagnosis, and medications for common ailments.

 

3. In terms of secondary health care, hospitalization and rehabilitation will be free.

 

4. The system should cover specialist services when it comes to tertiary health care.

LIMITATION OF THE STUDY

The challenges that this project encountered were primarily related to the nature of the research, but they were also a result of the research. They were also the result of the data collection method used. Many personnel were hesitant to give information to this effect, as the study’s theme implied at face value. Determined to succeed, the writer, despite severe time and cost constraints, used inside approaches to obtain the much-needed information. It was not a simple task to do the research. The researcher was transferring from one office to the next. It took a lot of patience on the part of the executives to provide the necessary information. The writer had to visit a lot of insurance companies to get the job done.

DEFINITION OF TERMS

The National Health Insurance Scheme is a government-sponsored insurance program that covers health-care costs and is funded by a combination of mandatory or voluntary contributions from all income-earning residents and government subsidies, with benefits available to all residents in need of medical care. Its definition is so broad that it tends to meet the government’s goal of ensuring that all of the country’s residents receive quality medical care. Various forms of health insurance schemes are included in the scope of such a National Health Insurance Scheme.

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