Expert Calls for Upward Review of NHIS Capitation


A health insurance expert, Mr Frank Osimi, on Saturday called on the National Health Insurance Scheme (NHIS) to review upward the capitation to healthcare services providers.

Osimi made the call at a book launch on health insurance scheme in Nigeria.

Capitation is a type of healthcare payment system in which a doctor or hospital is paid a fixed amount per patient for a prescribed period of time by an insurer or physician association.

The News Agency of Nigeria (NAN) reports that the book launch was held at the WODIA Training Institute, Ogba, Lagos.


Title of the book is: “Health Insurance Customer Executive.”

Osimi said that due to the rate of inflation and the rising cost of medical infrastructure and services, the capitation, which has been fixed since 2007, needed an upward review.

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“Funding has been the major challenge facing healthcare sector in Nigeria and all over the world.

“The NHIS scheme has been designed to help reduce the burden of paying out of the pocket.

“Capitation is the prepaid payment made by NHIS to the providers through Health Management Organisations (HMO) for primary healthcare services rendered to NHIS enrollees across providers in Nigeria.

“The capitation is for primary healthcare services for treatment of diseases such as malaria, fever, respiratory tract infections gastroenteritis, typhoid fever and others, however, the enrollee is expected to pay 10 per cent.

“Providers across the country have been continually asking for upward review of the capitation as it is too small compared to the services being rendered by service providers in the hospitals,” he said.

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Osimi said in spite of the low capitation, more patients were now visiting hospitals for one form or treatment or the other.

“On the other hand, NHIS argument is that though, the N750 may be small as capitation for an enrollee in a month, any hospital that has one thousand, two thousand or three thousand NHIS stands to receive substantial amount of money.

“In the sense that the N750 is paid per provider is multiplied by the total number of enrollees allocated by NHIS to a provider; in reality, most accredited hospitals have fewer enrollees.

“It is also worthy of note that more enrollees now visit hospital more often, maybe as a result of economic and social problems which has led to a burden of diseases experiences.

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“The service providers will like to provide the best of the services to their patients which did not come at a cheap price at all; the hospitals have been at the receiving end,” he said.

Osimi said that the book would be made available to the public at book stores and some designated medical centres, while the E-copy would be sold on Amazon and other E-market platform.

NAN reports that the book launch drew many stakeholders across the medical sector, the HMO providers, and government representatives among others. (NAN)


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