The Difference Between NHIA & NHIS

Many Nigerians may wonder – what exactly is the difference between the National Health Insurance Authority (NHIA) and the National Health Insurance Scheme (NHIS) in the country? Both are strategic organizations set up by the government to improve healthcare access to citizens. But they actually have different roles to play.

The NHIS focuses majorly on registering people into health plans and administering different government-sponsored programs that fund medical treatments. The NHIA on the other hand regulates the insurance providers, companies and health maintenance organizations to ensure efficiency of operations.

While both agencies ultimately aim to ease access to medical care and reduce out-of-pocket expenses for Nigerians seeking healthcare, understanding how the NHIA sets guidelines and oversees activities in the system, while the NHIS directly implements the insurance schemes, is key.

This article further explains their specific functions and how they complement each other.

THE DIFFERENCE BETWEEN NHIA AND NHIS IN NIGERIA

The National Health Insurance Scheme (NHIS) and the National Health Insurance Authority (NHIA) are two key organizations involved in healthcare financing in Nigeria. While they have some similarities in their goals and functions, there are also some key differences between the NHIS and NHIA.

WHAT IS NHIA?

The National Health Insurance Authority (NHIA) was established through the National Health Insurance Authority Edict of 1997 and later the National Health Insurance Scheme (NHIS) Act in 1999.

The NHIA was set up to regulate, supervise and ensure effective administration of health insurance schemes in Nigeria.

The key functions of the NHIA include:

• Registering and regulating health maintenance organizations (HMOs)
• Accrediting healthcare providers and ensuring they meet standards
• Ensuring compliance of HMOs to guidelines and standards
• Receiving and investigating complaints by stakeholders
• Supervising operations of the NHIS
• Sensitizing and promoting adoption of health insurance among Nigerians

So while the NHIS focuses on actual provision and administration of health insurance schemes targeting different segments of the Nigerian population, the NHIA focuses on oversight and ensures efficiency and standards within the Nigerian health insurance ecosystem.

At the helm of the NHIA is the Executive Secretary, Professor Muhammad Nasir Sambo. Prof Sambo has over 15 years expertise in health financing, planning, economics and policy formulation both locally and internationally.

WHAT IS NHIS?

The National Health Insurance Scheme (NHIS) was established in Nigeria in 1999 under Act 35 of the National Assembly. It aims to ensure that all Nigerians have access to quality and affordable healthcare services.

The goals of the NHIS include:

• Providing health insurance coverage for Nigerians against high costs of medical care
• Ensuring equitable distribution of healthcare costs across different income groups
• Maintaining high standards of healthcare delivery services within the scheme
• Ensuring efficiency in healthcare services
• Improving and harnessing private sector participation in the provision of healthcare services

The NHIS seeks to provide easy access to healthcare for Nigerians through various programs and initiatives including the formal sector social health insurance program, urban self-employed social health insurance program, rural community social health insurance program and other special social health insurance programs.

The NHIS is led by Dr Mohammed Dogo in the capacity of Executive Secretary. Dr Dogo is a consummate public health professional with vast experience working with partners to implement health programs at national and regional levels. His vision is to leverage his expertise to accelerate Nigeria’s drive towards Universal Health Coverage using health insurance as a vehicle for promoting access to quality and affordable healthcare.

KEY DIFFERENCES BETWEEN NHIA AND NHIS

Now to the focal point of this article, which is knowing the disparity between the National Health Insurance Authority and the National Health Insurance Scheme.

While the NHIA regulates health insurance schemes including those by the NHIS and private providers, there are some key differences between both in terms of structure, coverage and administration:

ORGANIZATIONAL STRUCTURE

The NHIS has its own governing council and an Executive Secretary appointed by the government. The NHIA however is governed by a board with the Executive Secretary appointed by the Council.

COVERAGE

The NHIS focuses on actual implementation and coverage through its various programs for different groups including formal sector workers, the informal sector and rural communities. The NHIA however regulates the schemes by various providers within this ecosystem including the NHIS.

ENROLLMENT AND REGISTRATION

While the NHIS handles actual enrolment and registration of beneficiaries for its schemes, the NHIA registers, accredits and regulates the HMOs that participate in serving beneficiaries.

PREMIUMS AND PAYMENTS

The collection of premiums from beneficiaries to fund health plans is handled by the NHIS. The NHIA does not directly deal with premium collections from beneficiaries.

ADMINISTRATION AND REGULATION OF PLANS

The NHIA regulates health plans including approving scope of coverage and premiums to ensure efficiency while the actual administration of the government-run plans under NHIS is directly implemented by NHIS in conjunction with their HMO partners.

SUPERVISION OF HMOS

A key role of the NHIA not applicable to the NHIS is oversight and supervision of HMOs in Nigeria including ensuring they meet standards in order to improve beneficiaries experience and outcomes.

SERVICE PROVIDERS ACCREDITATION

While the NHIA accredits healthcare providers including hospitals, clinics and facilities providing services within schemes, the NHIS signs them on and implements administration of access to beneficiaries within its own programs’ service provider network.

INVESTIGATING AND DISPUTE RESOLUTION

The NHIA investigates complaints from beneficiaries and other stakeholders regarding experience with HMOs and insurance providers. The NHIS investigates issues directly related to administration and service delivery under its programs.

CONCLUSION

To sum it up clearly, while both NHIA and NHIS ultimately want Nigerians to reap benefits from health insurance, the NHIA is the referee that sets guidelines and monitors players.

NHIS meanwhile does the actual work to get Nigerians from all works of life signed up and accessing medical care through well-suited plans. Their symbiotic functioning ultimately enables progress towards more Nigerians affording quality healthcare, which is often a crippling challenge for families.

Hopefully, the difference is now clear on what NHIA and NHIS uniquely bring to the table!