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The House of Representatives on Tuesday unveiled plans to investigate the implementation of the National Health Insurance Scheme (NHIS) across the country, amid growing public concerns over its effectiveness and the performance of Health Maintenance Organizations (HMOs).
This resolution followed the adoption of a motion of urgent public importance sponsored by Hon. Billy Osawaru, who raised alarm over the widespread dissatisfaction with the scheme and the challenges confronting HMOs tasked with healthcare delivery.
In his lead debate, Hon. Osawaru noted that the NHIS, established in 1999, was designed to “provide access to good healthcare services for Nigerians and protect families from financial hardship due to huge medical bills.”
He further highlighted that the 1999 NHIS Act was replaced by the National Health Insurance Authority (NHIA) Act of 2022, which mandates health insurance coverage for all Nigerians and legal residents, with the goal of achieving Universal Health Coverage (UHC).
According to him, the new Act provides a framework for a comprehensive, accessible, and affordable healthcare system, with the core objectives of promoting, regulating, and integrating health insurance schemes while ensuring equitable access to quality healthcare for all citizens.
Hon. Osawaru explained that under the current system, the NHIA contracts HMOs to provide healthcare services to beneficiaries, which include federal and state government workers, private sector employees, and other Nigerian citizens. These HMOs, in turn, engage hospitals and clinics to deliver the services.
However, he expressed concern that despite the scheme’s potential, it continues to face numerous challenges, such as low coverage, inadequate funding, and inefficient service delivery. He noted that only about 5% of Nigerians are currently enrolled in the scheme, and even those enrolled often encounter poor-quality services, limited access to essential medications, and high out-of-pocket payments despite being insured.
“The House is worried that beneficiaries frequently report medication stock-outs, low-quality drugs, and restrictions on the kind of tests or consultations they can access often being limited to general practitioners even when specialized care is needed,” he said.
He added that delays in payments from HMOs to healthcare providers often disrupt service delivery, forcing some hospitals and clinics to compromise on the quality of care, sometimes with fatal consequences. Hon. Osawaru also cited instances where NHIS subscribers are denied coverage for essential procedures such as Cesarean Sections (CS) and appendectomies.
The lawmaker stressed the need for urgent oversight to address these issues, improve service delivery, expand coverage, and ensure that Nigerians receive the quality healthcare promised by the scheme.
The motion was unanimously adopted by the House, and further legislative actions are expected in the coming days.
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