10 advantages & disadvantages of the national health insurance scheme

The National Health Insurance Scheme (NHIS) is a government initiative implemented in many countries, including Nigeria, to provide affordable and accessible healthcare services to citizens. 

In Nigeria, it is now known as National Health Insurance Authority (NHIA).

Here are 10 advantages and 10 disadvantages of the National Health Insurance Scheme.

What is the National Health Insurance Scheme (NHIS) and what Functions of NHIS

The National Health Insurance Scheme (NHIS) is a health insurance program established by the federal government of Nigeria in 1999.

The program was created to improve access to quality healthcare for all Nigerians by providing a basic health coverage package at an affordable cost. 

The NHIS is designed to ensure that all Nigerians have access to necessary healthcare services regardless of their socio-economic status. 

The NHIS operates under the National Health Insurance Authority Act of 2022, which gives it legal backing to regulate, supervise, and ensure that health insurance is provided in Nigeria. 

One of the clear functions of NHIA is to assist the authority in achieving Universal Health Coverage for all Nigerians.

Participation in the NHIS is voluntary, and individuals and families can choose from a range of health plans offered by various healthcare providers. 

The NHIS also provides coverage for some vulnerable groups, such as pregnant women and children under five years of age, at no cost.

10 advantages of the national health insurance scheme

1. Universal Healthcare Access

The NHIS aims to provide healthcare coverage for all citizens, ensuring that individuals and families have access to necessary medical services, regardless of their income level or socioeconomic status. 

2. Financial Protection

The NHIS offers financial protection by reducing out-of-pocket expenses for healthcare services. 

It helps individuals and families avoid the burden of high medical costs, ensuring that healthcare remains affordable and accessible. 

3. Enhanced Healthcare Services

With the NHIS, individuals gain access to a wider range of healthcare services, including preventive care, diagnostic tests, medications, and specialized treatments. 

It encourages individuals to seek timely and appropriate medical attention, promoting early detection and better management of health conditions. 

4. Improved Health Outcomes

The availability of healthcare services through the NHIS contributes to improved health outcomes. 

It facilitates early diagnosis, timely treatment, and ongoing medical support, reducing the risk of complications and improving overall health and well-being. 

5. Focus on Preventive Care

The NHIS emphasizes preventive care and health promotion. It encourages individuals to engage in regular check-ups, screenings, and preventive measures, which can help identify health risks early on and prevent the progression of diseases. 

6. Reduced Health Inequalities

The NHIS plays a vital role in reducing health inequalities by ensuring that healthcare services are accessible to all, regardless of their socioeconomic background. 

It helps bridge the gap between different segments of the population and promotes equitable healthcare delivery. 

7. Health Education and Awareness

The NHIS often includes health education and awareness programs, aimed at empowering individuals with knowledge about healthy lifestyles, disease prevention, and self-care practices. 

These programs contribute to better health literacy and empower individuals to make informed decisions about their well-being. 

8. Efficient Healthcare Delivery

The NHIS promotes efficient healthcare delivery by streamlining administrative processes, ensuring better coordination between healthcare providers, and optimizing resource allocation. 

It helps improve the overall quality and efficiency of healthcare services. 

9. Health Sector Development

The implementation of the NHIS often leads to the development and strengthening of the healthcare sector. It encourages investment in healthcare infrastructure, enhances capacity-building initiatives, and promotes research and innovation in the healthcare industry. 

10. Social and Economic Benefits

The NHIS has broader social and economic benefits. It contributes to poverty reduction by preventing catastrophic healthcare expenses and supporting financial stability for individuals and families.

It also promotes productivity by ensuring that individuals receive necessary healthcare services, allowing them to lead healthier and more productive lives.

10 disadvantages of the national health insurance scheme

While the National Health Insurance Scheme (NHIS) has numerous advantages, it is important to consider potential disadvantages or challenges associated with its implementation. 

Here are ten possible disadvantages of the NHIS: 

1. Limited Coverage

Depending on the specific design and implementation of the NHIS, there may be limitations in terms of the scope of coverage. 

Certain medical procedures, treatments, or medications may not be included in the insurance plan, leading to out-of-pocket expenses for individuals. 

2. Waiting Periods

Some NHIS programs may have waiting periods before individuals can access certain healthcare services. 

This can delay timely medical interventions, potentially impacting health outcomes, especially in urgent cases. 

3. Long Waiting Times

Due to an increased demand for services under the NHIS, there may be longer waiting times for appointments or treatments. 

This can be frustrating for individuals seeking prompt medical attention, particularly for non-emergency cases. 

4. Bureaucracy and Administrative Challenges

The NHIS involves complex administrative procedures, which can result in bureaucratic inefficiencies and delays in processing claims or approving treatments. 

Excessive administrative burdens may impact the efficiency of the healthcare system. 

5. Limited Provider Options

Depending on the NHIS program, individuals may be limited to a specific network of healthcare providers. 

This can restrict their choice of doctors, hospitals, or specialists, and may not align with their personal preferences or existing relationships with healthcare providers. 

6. Sustainability and Funding Issues

The long-term sustainability of the NHIS relies heavily on adequate funding and financial stability. 

Insufficient funding or challenges in maintaining a balanced risk pool can compromise the availability and quality of healthcare services. 

7. Fragmented Healthcare Delivery

In some cases, the NHIS may not effectively coordinate care across different healthcare providers and settings. 

This can result in fragmented healthcare delivery, leading to challenges in continuity of care and patient outcomes. 

8. Fraud and Abuse

The NHIS can be susceptible to fraud and abuse, including overbilling, unnecessary treatments, or falsified claims. 

Such practices can undermine the financial viability of the scheme and compromise the quality of healthcare services. 

9. Inequitable Access

Despite aiming for universal coverage, certain populations, particularly marginalized or vulnerable groups, may still face barriers to accessing the NHIS. 

Issues such as geographic disparities, lack of awareness, or difficulties in enrolling may contribute to inequitable access to healthcare services.

10. Dependence on Government Support

The success and sustainability of the NHIS often depend on consistent government support and commitment. 

Changes in government policies, budgetary constraints, or political factors may impact the effectiveness and continuity of the scheme.

What Next?

To address the disadvantages and optimize the benefits of the NHIS, several actions can be taken.

Last Updated on May 23, 2023 by Our Editorial Team