Health insurance is a financial arrangement that protects individuals from high medical expenses. When unexpected illness strikes, paying out-of-pocket can push families into poverty, a reality often called out-of-pocket expenditure (OOPE). Insurance spreads this financial risk across a large group of people.
Key components of health insurance include:
National health schemes operate at the federal level to achieve universal health coverage. In Nigeria, the National Health Insurance Authority (NHIA) serves as the main body regulating and promoting health insurance.
Federal programs typically cater to formal sector employees, such as civil servants, where employers and employees share the premium cost. Recent reforms also aim to capture vulnerable populations through subsidized or government-funded basic healthcare provisions.
While national schemes set broad policies, state governments implement State Health Insurance Agencies (SHIAs) to cover residents at the state level, particularly informal workers and rural dwellers.
For remote communities outside formal government structures, Community-Based Health Insurance Schemes (CBHIS) offer a localized alternative. Members of a village or trade association pool small amounts of money together to manage their basic health needs, fostering strong local ownership and trust.
Private health insurance companies operate for profit or as managed care organizations. Individuals or corporate organizations purchase these plans to access faster care, wider options of private hospitals, and specialized services not always covered by basic public schemes.
Private policies vary widely in cost and benefit packages. Clients often choose from different tiers, where higher premiums grant access to luxury hospital wards and international treatment options.
Sustainable health systems depend heavily on how funds are raised and managed. Revenue collection, pooling, and purchasing form the three pillars of health financing.
Risk pooling protects the individual by ensuring that funds collected from the healthy pay for the sick. Without effective pooling, high-risk individuals like the elderly or chronically ill would face unaffordable insurance costs, a problem known as adverse selection.
Nurses play a vital frontline role in the successful operation of health insurance schemes. They verify patient insurance status, document care accurately, and ensure that treatments rendered match the approved benefit package.
Furthermore, nurses educate patients on how to use their insurance cards, reducing friction at registration desks and ensuring clients receive the full services they are entitled to under their specific plan.