Towards the attainment of its Universal Health Coverage (UHC) goals, the Federal government has increased capitation and fee-for-service payments-two key payment mechanisms accruing to healthcare providers under the National Health Insurance Authority (NHIA), it emerged on Monday.
The new rates, which were revealed on Monday, marked the first major review in over a decade.
The latest review follows a temporary increase six months ago that witnessed 60% for capitation fees and 40% for fee-for-service payments was implemented at the time to stabilize the industry and manage rising costs while awaiting a full actuarial review to determine sustainable rates.
Under the latest revision, capitation, which is the fixed annual payment to healthcare providers per enrolled patient, increased by 93% compared to December 2023 while, fee-for-service payments, which reimburse providers for specific medical procedures and services, surged by an unprecedented 378% over the 2023 rates.
The Director General (DG) of NHIA, Kelechi Ohiri, said the development reflects the commitment of the NHIA, and other partners, to advance the Federal Government’s vision of an enhanced healthcare system for a healthier population and significantly improved national health outcomes.
While making the disclosure in Abuja on Monday during a stakeholders meeting with HMO’s and Healthcare Providers, the DG said the new rates are approved by the Minister for Health and Social Welfare, Prof. Ali Pate, based on the findings of the completed actuarial review, and will be implemented from April 2025
Stakeholders at the meeting include heads and representatives of Health Management Organizations (HMOs), Healthcare Provider Associations, and Committee of Chief Medical Offices (CMDs) of Federal Tertiary Hospitals, among others.
According to Ohiri, the adjustments not only aim to address outdated rates but also to align compensation with the reality of rising medical costs, and incentive quality care.
Emphasising that the revised tariffs aim to guarantee fair compensation, encourage providers to deliver top-quality services, and mitigate rising medical costs, he said, “Overall, the adjustments are tailored to provide better financial support for healthcare providers, leading to improved patient care and industry standards.
“Backed by actuarial analysis, the revised rates are designed to ensure fairness, sustainability, and improved healthcare service delivery.
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“These updates also strengthen consumer protection measures, ensuring patients receive better and more reliable care.
“The primary goal is to incentivize healthcare providers to deliver higher-quality services to enrollees”.
The DG however expressed hope that the increase in premiums would translate into enhanced services, noting that, “With the increase in premiums, we expect that the quality of care for enrollees will be improved and sustained.
“Providers are expected to deliver good quality care at no additional cost to enrollees, and NHIA will ensure strict enforcement”.
The stakeholders applauded the NHIA for its bold move to strengthen Nigeria’s push toward Universal Health Coverage and the impactful reforms.
They reaffirmed their commitment to ensuring health insurance enrollees fully benefit from the changes.