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 21st
January and 10th 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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