Nigeria Set to Revise Capitation Fees for Health Insurance Subscribers – NHIA

• Dr. Kelechi Ohiri reveals ongoing discussions to adjust capitation fees to improve healthcare accessibility within the national insurance program
• Addressing concerns among hospital proprietors, Dr. Ohiri emphasizes the significance of fee reviews and the establishment of the Vulnerable Group Fund

Dr. Kelechi Ohiri, Director-General of the National Health Insurance Authority (NHIA), has revealed ongoing deliberations regarding adjusting capitation fees allocated to healthcare providers within the national health insurance program. This initiative forms part of a broader strategy to enhance healthcare accessibility for Nigerians.

Capitation fees represent monthly remunerations disbursed to healthcare facilities per patient enrolled in the health insurance scheme, as contractual agreements outline.

Addressing a gathering focused on insurance accessibility for Nigerians, Dr. Ohiri acknowledged a prevalent concern among hospital proprietors regarding the current capitation fees. He emphasized the significance of this issue, noting its prolonged neglect in fee reviews.

“At NHIA, upon assuming office, one of our primary actions was to initiate actuarial assessments commencing in February,” Dr. Ohiri elaborated. “These assessments aim to provide empirical data for tariff revisions and establish a baseline for determining a basic package of services.”

Furthermore, he highlighted the establishment of the Vulnerable Group Fund, emphasizing the government’s commitment to subsidizing healthcare costs for the indigent population. This dual approach, he clarified, encompasses both contributory and non-contributory health insurance models.

With only approximately 16 million individuals, roughly 7% of the national populace, currently covered by health insurance, Dr. Ohiri underscored the imperative of expanding coverage. He cited the recently enacted NHIA Act as pivotal in empowering the agency to undertake this endeavour.

“Universal coverage is our aspiration,” Dr. Ohiri emphasized. “The NHIA Act mandates us to drive this agenda forward, aiming to increase coverage beyond the existing 7% significantly.”

The ongoing review of capitation fees signals a proactive step towards fortifying Nigeria’s healthcare landscape and advancing the nation’s journey towards universal health coverage.