NHIA boosts fee-for-service payments to hospitals by 373%

The Director-General and Chief Executive Officer, National Health Insurance Authority, Dr Kelechi Ohiri.

The National Health Insurance Authority has increased reimbursements to healthcare providers under its fee-for-service arrangement by 373 per cent as part of efforts to improve service quality and restore public confidence in Nigeria’s health insurance system.

The Director-General of the NHIA, Dr Kelechi Ohiri, disclosed this on Thursday during a joint quarterly media briefing organised by the authority and the National Primary Health Care Development Agency.

Ohiri said the increase followed an actuarial review of existing healthcare tariffs, which had not been revised for a decade despite rising costs of medicines and medical services.

He explained that the review also resulted in a doubling of capitation payments to healthcare providers, while the revised tariffs were designed to reflect prevailing market rates.

According to him, the adjustments, which took effect on April 1, 2025, were intended to ensure that healthcare facilities received adequate reimbursement for services provided to health insurance enrollees.

“We launched an actuarial review of the existing tariffs. These had not been increased or revised in a decade, and we know that the cost of medicines has been increasing.

“What we did was to review them using the same principles, which resulted in a doubling of what is paid for in capitation and a 373 per cent increase in what was reimbursed in terms of fee for service,” he said.

The NHIA chief said adequate reimbursement was essential to improving healthcare quality, noting that complaints persisted about patients being denied services covered by their insurance or being asked to pay out of pocket for medicines and treatments.

He said the authority had introduced additional measures to address these challenges, including a directive requiring hospitals to commence treatment if authorisation codes were not issued within one hour.

Ohiri added that the NHIA had strengthened its complaints-resolution mechanism, with about 87 per cent of complaints received in the preceding year resolved within 48 hours.

He said the authority had also imposed sanctions in cases involving improper charges, including ordering refunds to enrollees who paid for services already covered by their insurance. Other measures included delisting healthcare facilities and sanctioning health maintenance organisations.

The director-general disclosed that NHIA personnel had been deployed to 19 high-volume healthcare facilities in the Federal Capital Territory to help resolve complaints and address challenges encountered by enrollees.

He said the measures were part of broader efforts to rebuild public trust and ensure that increased insurance coverage translated into better healthcare experiences.

Ohiri further disclosed that the number of Nigerians covered by health insurance had risen by 42 per cent, from approximately 16 million in January 2024 to 23.02 million.

He added that 3.18 million poor and vulnerable Nigerians were benefiting from government-funded health insurance under the Basic Health Care Provision Fund.

The NHIA boss said the authority would continue working with healthcare providers, government agencies, the media and civil society organisations to improve accountability, expand coverage and strengthen access to quality healthcare.

The National Health Insurance Authority Act, 2022, established a framework for mandatory health insurance for residents and strengthened efforts to expand access to healthcare financing.

However, the cost of medical services and reliance on out-of-pocket payments remain significant challenges for households seeking healthcare.

The NHIA’s tariff review and reimbursement adjustments are intended to improve the financial sustainability of healthcare providers participating in insurance schemes and support the delivery of services covered by enrollees’ benefit packages. Adequate reimbursement, effective oversight and compliance by healthcare providers remain essential to ensuring that insurance coverage translates into accessible, quality care.