Coverage Under NHIS: Imperatives of Healthcare Trust

Bunkaya Bitrus Gana

This educative article attempts a highlight of some of the salient aspects of the National Health Insurance Act, 2004, its operation and how the lacunae in the Act excluded a wider percentage of Nigerians from accessing healthcare. The article also attempts a summary of the Healthcare Trust Plan, its modus operandi and how it helps to extend the dragnet of healthcare provision to Nigerians, giving them a platform to access medical services using the same Health Maintenance Organisations (HMO’s).

The National Health Insurance Scheme was established under the NHIS Act, 2004 as a social health insurance system aimed at providing quality and affordable healthcare for all Nigerians and those legally residing within Nigeria. The scheme essentially pools together funds contributed by the members of the scheme and then periodically release those funds to purchase medical services through registered Health Maintenance Organisations (HMO’s). As a social health security and risk management scheme, it not only ensures access to medical care to all members of the scheme but also works towards mobilising and distributing medical resources in a fair and proportionate way.

The NHIS protects the vulnerable and financially handicapped members by reducing the use of out-of-pocket expenses in the attainment of healthcare services as well as sharing the risk of spending on healthcare amongst a large group of people. We all know that a large percentage of the Nigerian population rely on private funding for medical care and therefore those who are unable to afford to pay out of their pockets are put at an incredible disadvantage and this creates an imbalance in the distribution of medical resources. It is therefore correct to say that a significant portion of the population is being denied access to healthcare resulting in high degree of preventable deaths and a general poor state of health among the populace. The scheme, it was believed would help to tackle this issue by ensuring equal access to healthcare for all members of the public regardless of financial status.
When it was set up in Nigeria in 2005, it was projected that the scheme would achieve universal healthcare by 2015. Sadly, this goal has not been met. Nonetheless, the scheme operates several programmes that allow for the coverage of different sectors of society.

For lack of space, we would briefly describe one of the most widely practised programmes only: The FSSHIP (Formal Sector Group has the Formal Sector Social Health Insurance Programme). This programme is targeted at the public sector employees, employees in the organized private sector and the Armed Forces, Police, and other uniformed officers. Here, a fixed percentage of the employee’s earnings are deducted and contributed to the fund by both the employer and employee. For the public (federal) sector, the employer is to pay 3.5% while the employee is to pay 1.75% of the employee’s salary. For the private sector and the other tiers of government, the employer pays 10% while the employee pays 5%.
The employer could also undertake to pay the entire 15% or more for extra coverage on the benefit package. The contributions provide health care services for the employee, his/her spouse and four biological children under the age of 18. If an employee wishes to add more dependants under his package, he would be required to make additional contribution. Whereas this scheme is made compulsory by the Government, same cannot be said of the informal sector. According to stakeholders of the scheme, as of 11th January 2021 the Federal Government had been making the entire contribution on behalf of all employees in the public sector. The only exclusion are employees of the NHIS. This provides a practical explanation for the higher success rate of the scheme in this sector.

Despite the wide and ever-growing framework of the NHIS, there are still glaring gaps in the system. As has been established, the system takes account of employees in the formal an informal sector, students in tertiary institutions and vulnerable members of society. However, it fails to consider retired Nigerians who have ceased to access medi-care under the NHIS. This is a massive oversight on the part of the government considering that about 3.1% of the Nigerian population are aged 65 and above which is the retirement age range in Nigeria. That is not to say that those within this age range are all retired or those below it cannot retire. The pertinent point here is that a significant enough percentage of the population fall into this excluded group which also deserve easy access to quality affordable healthcare.

The use of Healthcare Trust is a good alternative of accessing quality and affordable healthcare. It is is a type of private trust that is designed to assist two sets of Nigerians, viz: (i) Nigerians in diaspora who carry the burden of funding the medical expenses of their loved ones residing in Nigeria and (ii) retired public and civil servants here in Nigeria, who are unable to benefit from the NHIS because they have retired from paid employment and are therefore ineligible to access medical care through that scheme.
Instances abound where monies sent by Nigerians living abroad for the treatment of their relations here in Nigeria are diverted. Similarly, even when the money gets to the intended recipients, the quality of the health care provided by some of our healthcare facilities in Nigeria are substandard and unable to cater for certain types of ailments. Thus, whereas the poor guy keeps sending money for the medi-care of his relations, the money is either diverted, never used for the intended purpose(s) or the health facilities within that locality do not possess the requisite equipment or personnel to handle such ailments. The result is usually catastrophic as the patient dies from diseases that a good medical facility could easily have handled. This is where the Healthcare Trust becomes very important.

Through the HCT, Nigerians in diaspora can set up a Trust for their family members here in Nigeria to access healthcare through HMO’s and registered medical facilities. Once funded, the Trustee to the trust engages a registered HMO and periodically release the funds in the trust to make regular premium (usually subsidised) payments to the HMO to secure a healthcare plan on behalf of the beneficiaries to the Trust. Once set up, the settlor (the person setting it up) need not worry about the day-to-day management of the trust or the operation of the plan because the trustee handles the entire process. The Settlor receives periodic reports on how the Trust is managed and how the medical needs of the registered beneficiaries are being taken care of. That is the beauty of the healthcare trust.

• Bunkaya Bitrus Gana Esq is the Managing Director, Greenwich Trustees Limited.

Similarly, the HCT gives the retired Public or Civil Servant who becomes ineligible to access healthcare under the NHIS because he is retired the opportunity to access affordable healthcare under the NHIS. We have realised that excluding this vulnerable segment of the society from the NHIS also means excluding all members of his family from enjoying what was easily available when the retiree was in active service. Hence, the HCT steps in to assist the retired civil servant to set up and fund his HCT to cater for the medical needs of his family and himself. Using the HCT, the Settlor will continue to enjoy subsidised medi-care for himself and the named beneficiaries as if he was still in active employment.

• Bunkaya Bitrus Gana Esq is the Managing Director, Greenwich Trustees Limited.

• Rt. Hon. Dr. Eddie Mbadiwe writes from Abuja.