Abstract:

The Nigerian government established the National Health Insurance Scheme (NHIS) under Act 35 of 1999 with the aim of improving access to health care and reducing the financial burden of out-of-pocket payment for health care services. The NHIS became fully operational in 2005.

The aim of the study was to document behaviours and practices that constitute moral hazards among service providers and clients of the NHIS in health facilities in Ilorin Metropolis, North Central, Nigeria. Qualitative methods through 12 Focused Group Discussions (FGDs) and 4 individual in-depth interviews were conducted between between 21^st January and 10^th March 2019. Data were analysed using thematic analysis. FGDs and in-depth interviews showed that community members, health providers and NHIS officers are aware of various behaviors and practices that constitute abuse of the scheme. Behaviors such as frequent and unnecessary visits to health facilities, proxy consultation, impersonation, feigning sickness to collect drugs for non-insured persons, over charging for services provided to clients, charging clients for services not provided and over prescription were identified. All the recommendations by the respondents are quite pertinent and both NIHS and Government should see to their implementation because they will help to address most of the identified moral hazard behaviours. Cost containment strategies should be pursued to prevent or reduce financial loss to the NHIS. Minimizing financial loss ensures the smooth operation of the scheme and guarantees its sustainability which is good for all the stake holders.

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