IMPROVING THE IMPLEMENTATION OF THE IMO STATE HEALTH INSURANCE SCHEME

Health insurance is an insurance contract taken to cover the cost of medical care. The contract can be annually, monthly or over other fixed and certain periods of time. It typically caters for health care expenditure such as medical, surgical, prescription drugs, dental and other expenses incurred by the insured.’ Health insurance can be comprehensive or apply to a limited range of medical services. It may provide for full or partial payment of the costs of specific services. This is usually dependent on the quantum of the premium. Health insurance can reimburse the insured for expenses incurred from illness or injury treatments accessed or pay the health care provider directly.’ It ensures that individuals and families have access to health care services without any financial difficulty as opposed to out-of-pocket expenditure. The major difference between health insurance and out-of-pocket health expenditure is that the latter insists that patients pay upfront to access health care services whilst health insurance provides the insured or enrollees access to health care services which payments would be settled from the pool of contributions (premiums) paid by all the insured in the health plan. The salient elements that are basic to all the health insurance varieties include: advance remittance of premiums into the pool, gathering funds together, and being eligible to enjoy the benefits for payment of premiums made, or for being employed in situations where employment entitles a person to enjoy the benefits of health insurance. It is imperative to distinguish between health insurance and publicly funded healthcare system which provides coverage for every citizen or resident under a free healthcare program. For instance, healthcare services available to indigent and poor persons under the Basic Health Care Provision Fund (BHCPF) under S.11 of the National Health Act (NHA) are not based on any premiums paid by the beneficiary but are funded through the statutory 1 percent of the Consolidated Revenue Fund of the Federal Government.’ This is also the status of the Equity Fund used to cater for indigent and vulnerable persons created by S.19 (2) (d) of the Imo State Health Insurance (ISHIL) Law.

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