Health
Health providers seek insurance reforms to cut out-of-pocket spending
By Janet Ogundepo
Healthcare providers, under the aegis of the Healthcare Providers’ Association of Nigeria, have called for urgent reforms to Nigeria’s health insurance system, warning that despite rising enrolment, most Nigerians still pay for healthcare from their pockets, leaving many households financially vulnerable when illness strikes.
The healthcare providers said expanding coverage to traders, artisans, transport workers and small business owners would require affordable contribution plans, timely reimbursement of healthcare providers and the integration of community pharmacies into health insurance networks.
HCPAN called for stronger collaboration between regulators, insurers and frontline professionals to expand coverage, improve service delivery and ensure that health insurance translates into accessible, quality care for Nigerians.
They made the call at the 2026 Annual Scientific Conference and Annual General Meeting of HCPAN Lagos State chapter, held at the Lagos Chamber of Commerce and Industry building in Lagos on Tuesday.
The conference was themed, “Expanding Health Insurance Coverage in Nigeria: Improving Community-based Insurance Schemes in the Informal Sector.”
In his keynote address, the Chief Executive Officer of Drugstoc Limited, Dr Chibuzo Opara, represented by the company’s Head of Business, Damilare Ojo, said Nigeria must move beyond increasing enrolment figures to ensuring that insured people could access quality care and prescribed medicines without financial hardship.
He further said that health insurance should be assessed not only by the number of people enrolled but also by whether beneficiaries could obtain care when they needed it.
“The real test is when people can obtain quality health care, access prescribed medications, and continue treatment without placing their household under financial strain,” he said.
Opara further noted that although health insurance enrolment had risen to about 22 million, the figure covered barely 10 per cent of Nigeria’s population.
He said government figures also showed that out-of-pocket payments accounted for more than 71 per cent of Nigerians’ healthcare spending, meaning many people still had to pay directly for treatment when they were most vulnerable.
“People are more likely to trust insurance when they can see its value in practice,” he said.
Opara argued that the informal sector required insurance arrangements that reflected the realities of workers whose earnings were irregular.
“For traders, artisans, transport workers, and small business owners, irregular income makes applying for health care insurance very difficult because they cannot make fixed contributions,” he said.
He urged regulators and insurers to develop flexible contribution mechanisms, appropriate benefits packages and group enrolment arrangements through trusted associations to make coverage more accessible.
The Drugstoc CEO also identified a lack of trust as a challenge to expanding insurance, saying beneficiaries needed clear information about the services covered, exclusions and any additional payments they might be required to make.
He said the system must provide “a credible route to care when members truly need it.”
Opara called for greater integration of community pharmacies into health insurance networks, arguing that their accessibility could help connect more Nigerians to healthcare services.
He said many Nigerians seeking care for common health concerns were more likely to visit pharmacies than hospitals or primary healthcare centres, making pharmacies an important point of contact for expanding coverage.
“Community pharmacies are familiar and accessible, and they are the main point of contact for many Nigerians,” he said.
He stressed, however, that pharmacies should not replace other healthcare professionals but should operate within a coordinated system with clear referral pathways and defined professional responsibilities.
Opara added that effective collaboration among insurers, pharmacists, clinicians, diagnostic professionals, technology providers, medicine suppliers, government and regulators was essential to making insurance work for beneficiaries.
He also called for reliable reimbursement arrangements, noting that delays in payment could undermine healthcare providers’ ability to restock essential medicines and sustain services.
“When you offer services, and you have to wait 60 to 90 days to be reimbursed for care you have offered, with interest rates from loans from different financial institutions eroding into what should have been the profit,” he said.
Opara similarly called for the review of payments to healthcare providers, saying capitation rates should reflect prevailing economic realities while keeping insurance affordable for enrollees.
He said the review should be carried out collaboratively to ensure that providers could deliver appropriate care without placing an unsustainable financial burden on patients.
Speaking on the conference’s sub-theme titled, “Opportunities and challenges of participation of diverse healthcare professionals in the upscaling of health insurance in Nigeria,” the Lagos Zonal Director of the National Health Insurance Authority, Femi Adeoye, represented by Chinenye Nwaohiri, said health insurance remained the most effective way to protect Nigerians from the financial burden of healthcare since out-of-pocket payments continued to make treatment difficult for many households.
He said families without insurance often delayed seeking care, explored alternatives or abandoned treatment because they could not afford the cost.
“Insurance is not merely a prepayment; it is a lifeline. It is a social protection tool, and a strategic investment in Nigeria’s health and development,” he said.
The NHIA official said the authority’s interventions in extending coverage to vulnerable populations were intended to remove financial barriers to essential healthcare, including maternal services, emergency care and treatment for conditions affecting vulnerable women.
Adeoye, however, acknowledged that significant gaps remained despite the expansion of health insurance programmes, noting that millions of Nigerians were still without coverage.
He said the evolving insurance system presented opportunities for healthcare professionals, but stressed the need for sustainable financing, stronger provider participation and quality service delivery to ensure that expanded coverage translated into accessible care.
The President of HCPAN, Dr Austin Aipoh, also called for improvements in healthcare financing, especially in the payments made to providers under health insurance schemes.
Aipoh said the informal sector represented a significant opportunity for expanding coverage because it included artisans, traders, mechanics and others outside government employment.
He said healthcare providers had an important role in encouraging people to enrol because they interacted with patients daily and could explain the benefits of insurance.
He said delayed payments and inadequate reimbursement remained major challenges for providers.
Aipoh called for a fresh actuarial study to determine the actual cost of delivering healthcare services, taking into account rising expenses, including medicines, electricity and the cost of running health facilities.
He said the government also needed to make more funding available for the health sector.
“There’s so much to be done,” Aipoh said, adding that the current level of government funding for healthcare was inadequate.
The outgoing chairman of HCPAN Lagos State chapter, Pharm. Biola Paul-Ozieh, said health insurance coverage remained inadequate after about 22 years of practice in Nigeria.
She noted that out-of-pocket expenditure remained high despite the mandatory health insurance provision in the National Health Insurance Authority Act of 2022.
Paul-Ozieh also identified the limited coverage of vulnerable groups, the exclusion of some healthcare professionals from insurance networks, delayed payments and tariffs that did not reflect current economic conditions as challenges affecting the system.
She called for the coverage of Nigerians in the informal sector through innovative ways to improve community-based health insurance schemes.
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