Table 2 Results of application of the checklist to social health insurance scheme (SHIS) design in Kaduna and Niger States
From: A checklist for designing health insurance programmes – a proposed guidelines for Nigerian states
Key design variables | Question to be answered | Kaduna | Niger |
|---|---|---|---|
Sources of finance | How would funds for the SHIS be generated/Collected | • Initial take-off grant • Equity contribution of 1% consolidated revenue fund • Contribution from employers, employees in public and private sector • Contributions from informal sector • Contributions from students in tertiary institutions • Funds from the national health insurance scheme (NHIS) for pregnant women, children under 5 • Donations • Appropriations earmarked for implementation of scheme • Fines and commissions charged by agency • Dividends and interests on investments | • Initial take-off grant • Equity fund of 1% consolidated revenue fund • Formal sector contribution of public and private employers and employees • Informal sector contribution • Funds from NHIS for pregnant women and children under 5 • Donations or grants • Fines and commissions charged by the agency • Appropriations earmarked for implementation of the scheme • Dividends and interests on investments and stocks |
Is it pro-poor? | The scheme appears to be pro-poor as there is an equity fund established for the vulnerable groups | The scheme appears to be pro-poor as there is an equity fund established for the vulnerable groups | |
Is collection feasible? | Most likely; although, government funds are dependent on availability of funds/budget release. There is, however, no mechanism to collect contributions from informal sector | Most likely for most part; although, the informal sector will be more challenging | |
Will it be sufficient? | Not likely; a fiscal space for health is ongoing. Compliance rate will determine how sufficient the funds will be | Several factors will determine how sufficient it will be; compliance rate and budget release | |
Benefit package | What packages are offered | Essential services | A mix of essential and/or comprehensive packages will be offered depending on the health plan. |
Will the system have enough projected revenue to pay all its cost? | Most likely; provided the benefit packages are well costed based on population needs and utilisation rates | Not likely; a major source of fund needs to be established with adequate capacity to collect contributions. Adequate costing done for the different health plan package of service | |
Provider payment mechanism | How will providers be organised and compensated? | Discussions are ongoing Capitation/performance-based financing (PBF) will be adequate since it is one basic plan for all | Discussions are ongoing; however, a mix of capitation and PBF can be proposed for outpatient and inpatient services, respectively |
Are they efficient in cost containment to ensure high quality care is provided at the lowest possible cost? | If designed properly, yes. The state is providing a basic health plan to all members of the scheme. Either capitation/PBF can curb cost and provides an incentive for provider to offer quality service. Although capitation runs a risk of providers neglecting clients too. | Most likely especially if designed properly; although PBF might be associated with high administrative cost due to verification exercise but it can be merged to the activities of the scheme | |
Contributing population and level of compulsion | Will membership be compulsory or voluntary? | Mandatory for all residents | Mandatory for all residents |
Is it efficient for cross subsidisation? | Not likely; although if the compliance rate is high there is a chance of efficient cross subsidisation. In addition, if the subsidies for the vulnerable are pooled to the fund | Most likely only if the compliance rate is high | |
Feasibility of collection: are appropriate structures in place? | The scheme has no appropriate structures in place to collect contributions from informal sector and the formal sector might resist | The scheme has no appropriate structures in place to collect contributions from informal sector and the formal sector might resist | |
Pooling of funds | Are funds combined in a single or multiple pool? | Single centralised pool | Single centralised pool |
Is it efficient for risk equalisation/cross subsidisation? | Yes – Provided compliance rate is high; it means both low- and high-risk groups are within the pool | Yes – Provided compliance rate is high; it means both low- and high-risk groups are within the pool | |
Administration and management | Who will be responsible for oversight and monitoring the social health insurance system? (Administrative autonomy) | Executive secretary of the agency will provide oversight An actuary will be responsible for benefit packages | Executive secretary of the agency will provide oversight An actuary will be responsible for benefit packages |
Are appropriate structures available to monitor and address issues relating to quality, utilisation, cost, efficient and provider payments? | Uncertain; although the actuary is an independent consultant most likely from the private sector Tasked with the responsibility of reviewing benefit packages, utilisations and contributions | Uncertain; although the actuary is an independent consultant most likely from the private sector Tasked with the responsibility of reviewing benefit packages, utilisations and contributions |