National Health Insurance Scheme (NHIS)

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National Health Insurance Scheme (NHIS)

• Pharm. Dr. Mrs. C.O. Olumese
• UBTH Benin City
• 08072220360
• 08023381884

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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

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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

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NHIS- Introduction

• The quality of health of a countrys 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 governments efforts in this regard.

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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).

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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
  

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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

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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

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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

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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

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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

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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

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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.

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NHIS-Classification of HMO

• Zonal HMO
• National HMO
• Function of HMO

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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.

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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
  

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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.

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NHIS-OPERATORS

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

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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

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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

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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

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NHIS-OBLIGATION

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

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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

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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.

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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
•  

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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

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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.

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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).

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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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