National Health Insurance Scheme (NHIS)

National Health Insurance Scheme (NHIS) Pharm. Dr. Mrs. C.O. Olumese UBTH Benin City 08072220360 08023381884

National Health Insurance Scheme (NHIS) • Introduction • Definition • Objectives of NHIS • The NHIS Council • Contributors • Stakeholders In NHIS • Health Maintenance Organizations (HMOS) • NHIS Operators • Steps To Take In Enrolment Into NHIS

NHIS outline contd. • Payment Systems For Services Rendered • Guidelines For The Registration Of Pharmacies And Pharmacists • Guidelines On Registration Of Government Hospitals • Contractual Agreement With HMOS • Contractual Agreement With NHIS

NHIS- Introduction • The quality of health of a country’s population no doubt enhances productivity, economic growth and development. • In spite of the resource constraints, government is committed to improving health care delivery in Nigeria • The National Health Insurance Scheme (NHIS) is one of the government’s efforts in this regard.

NHIS-Definition • It is the national pooling of contributions from the incomes of eligible persons to provide standard healthcare services to them and their dependants. • The Scheme was established by the National Health Insurance Scheme Act, 1999 (No. 35 of 1999).

NHIS-Objective • To ensure that every Nigerian has access to good health care services. • To protect families from the financial hardship of huge medical bills. • To ensure the availability of funds to the health sector for improved services • To ensure the equitable distribution of health care costs among different income groups. • To limit the rise in cost of health care services

NHIS-Objective contd. • To ensure efficiency in health care services • To ensure adequate distribution of health facilities within the federation. • To ensure adequate patronage of all levels of health care • To maintain high standard of health care delivery services within the scheme • To improve and harness private sector participation in the provision of health care services

NHIS-The NHIS Council Responsibilities: • To manage the scheme in accordance with the provision of the act • To determine the overall polices of the scheme including the financial and operative procedures of the scheme • To ensure the effective implementation of the polices and the procedures of the scheme

NHIS-The NHIS Council contd. • To assess from time to time, the research consultancy and training program relative to the scheme • To arrange for the financial and medical audit of the zonal health insurance offices established under the section 21 of the act. • To ensure public awareness about the scheme

NHIS-The NHIS Council contd. • To coordinate quarterly returns from the zonal health insurance offices • To coordinate manpower training under the scheme. • To set guidelines for effective corporation with other organizations to promote the objective of the scheme • To carry out such other activities as are necessary and expedient for the purpose of achieving the objective of the scheme as set out in the act

NHIS-Contributors • any employer who has a minimum of 10 employees • 15% of the basic salary to be contributed • 5% by the employee • 10% by the employer

NHIS-Stakeholders • THE INSURED • THE EMPLOYERS • HEALTH CARE PROVIDERS .Primary health care providers .Fee-for service health care providers a. Secondary health care providers b. Tertiary health care providers

NHIS-Health Maintenance Organizations (HMOS) • DEFINITION: The HMO is a private or public institution body, corporate or a provident association registered by the scheme to utilize its administration to provide health care services through health care facilities approved by the scheme.

NHIS-Classification of HMO • Zonal HMO • National HMO • Function of HMO

NHIS-Function of HMO • To collect contributions from eligible employers, employees and other contributors to the NHIS. • To ensure that all contributors have easy and unhindered access to and receive appropriate health care services from the accredited health care providers. • To make payments to health care providers for service rendered. • To maintain quality assurance in the delivery of health care benefits to the insured persons. • Rendering returns to the scheme as required.

NHIS-HMO contd. • Registration requirements • Registration with corporate affairs commission • certificate of incorporation, articles of association and trust agreement e.t.c. • evidence of financial viability • Maintenance of account with NHIS approved banks • Insurance with an NHIS approved insurance company

NHIS-HMO contd. • Completion of prescribed application form including the following information • Names and addresses of the principal officers • Ownership structure and composition of the organization • Possession of necessary staff and infrastructure including computerization • Payment for stipulated registration, guidelines and other sundries.

NHIS-OPERATORS • NHIS council • Health Maintenance Organization • Heath Care Providers • State Health Insurance Arbitration Boards • Standards Committee • State Health Insurance Boards

NHIS-STEPS TO TAKE IN ENROLMENT • Fill an NHIS registration form and select any hospital of your choice from the NHIS accredited list of hospitals / clinics as your primary health care provides • Get enrolled • Receive NHIS ID card • Attend hospital when in need at no extra cost

NHIS-Payment Systems For Services Rendered • CAPITATION- payment made in advance to a health care provider • FEE FOR SERVICE- paid for specific services and prices per item

NHIS-Requirements For Approval And Registration Of Pharmacies And Pharmacists • Approval and be registered by the HMO despite being registered by PCN • The pharmacy shall be pharmacists owned • Standards Of Premises

NHIS-OBLIGATION • OBLIGATION OF THE GOVERNMENT OR PRIVATE PHARMACY • OBLIGATIONS OF THE HMOS

NHIS • REGISTERED PROVIDER: means a Pharmacy registered under the scheme. • ‘DRUG’: includes any substance or mixture of substances listed in the NHIS formulary • ‘ARBITRATION BOARD’: means the National Health Insurance Arbitration Board

NHIS • ‘BILL’: means the sum total of drug costs on all prescriptions presented for payment and the agreed professional charge calculated per prescription. • ‘SUBSCRIBER’: means anybody who contributes to the fund and is therefore insured under the regulation establishing the scheme.

NHIS • PRIMARY MEDICAL CENTRE: provide enlistment and initial encounter facilities for enrollees of NHIS outpatient facilities shall have the following minimum features • - Waiting and reception areas • - Consulting room • - Treatment room with cabinet, dressing, injection, trolley wash hand basin injection trolley etc. • - Adequate Dangerous Drug Act cupboard • - Patients toilet facilities • - Drug dispensing room • - Sterilizer

NHIS-SECONDARY / COMPREHENSIVE HEALTH CARE CENTRE both out patient and in patient services for general, medical, surgical, pediatric and maternal care. They should also have diagnostic and treatment facilities like: • - Laboratory including blood bank • - X-ray and allied diagnostics • - Surgical operating theatre • - Pharmacy dept • - Lying in ward with locker for each bed • - Separate ward for male and female • - First stage labor room

NHIS-SECONDARY / COMPREHENSIVE HEALTH CARE CENTRE contd. • Sterilizer • Isolation and sluice room • Public health facilities • Fire extinguisher • Nurses bay • Doctors room • There shall be appropriate administrative outfit for proper co-ordination.

NHIS-REQUIREMENTS FOR REGISTRATION • PERSONEL: • Primary Care: one (1) medical practitioner 2 registered nurses 2 hospital assistants 1 administrative staff Dispensary (supervised by qualified pharmacists).

NHIS-REQUIREMENTS FOR REGISTRATION • Secondary / Comprehensive Health Care Centre • Not less than one (1) registered medical practitioner in relevant areas of medical practice and specialties • Not less than four (4) registered nurses and midwives • Not less than four (4) hospital assistants • Not less than two (2) admin staff.

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National Health Insurance Scheme (NHIS)