Health providers seek insurance reforms to cut out-of-pocket spending

Healthcare providers in Nigeria have demanded urgent structural changes to the national health insurance framework, warning that current systems fail to protect households from financial ruin during illness. Speaking at a recent gathering in Lagos, representatives from the Healthcare Providers’ Association of Nigeria (HCPAN) stated that despite rising enrollment numbers, the majority of citizens continue to pay for medical care directly. They argued that meaningful reform requires integrating community pharmacies into insurance networks, establishing affordable contribution plans for informal workers, and ensuring timely reimbursement for providers. The calls for change were issued during the 2026 Annual Scientific Conference and Annual General Meeting of the HCPAN Lagos State chapter. The event took place on Tuesday at the Lagos Chamber of Commerce and Industry building. The conference focused specifically on improving community-based insurance schemes within the informal sector. Organizers emphasized that expanding coverage to traders, artisans, transport workers, and small business owners is critical to reducing out-of-pocket spending. Dr. Chibuzo Opara, Chief Executive Officer of Drugstoc Limited, delivered the keynote address via his representative, Damilare Ojo, the company’s Head of Business. Opara cautioned that increasing enrollment figures alone is insufficient. He asserted that the true measure of success is whether insured individuals can access quality care and prescribed medications without facing financial hardship. According to Opara, health insurance should be evaluated based on beneficiary experience rather than mere registration counts. Data presented at the conference highlighted the scale of the problem. Although health insurance enrollment has reached approximately 22 million people, this figure represents barely 10 percent of Nigeria’s total population. Government statistics cited by speakers indicated that out-of-pocket payments account for more than 71 percent of all healthcare spending in the country. This heavy reliance on direct payment leaves many families financially vulnerable when disease strikes. Opara noted that public trust in insurance grows only when people witness tangible value in practice. The discussion centered heavily on the unique challenges faced by the informal sector. Workers in this category often earn irregular incomes, which makes standard fixed-contribution insurance models inaccessible. Opara explained that traders and artisans cannot easily commit to regular premiums due to fluctuating earnings. Consequently, he urged regulators and insurers to create flexible contribution mechanisms. He proposed group enrollment arrangements through trusted associations and benefit packages tailored to these specific economic realities. Pharmacist Biola Paul-Ozieh, Chairman of the HCPAN Lagos Branch, reinforced these points. She stated that only between 10 and 13 percent of the Nigerian population currently holds health insurance coverage. Despite the mandatory provisions of the National Health Insurance Authority Act of 2022, out-of-pocket expenditure remains high, hovering around 70 percent. Paul-Ozieh pointed out that coverage for vulnerable groups stands at approximately 3.8 million individuals. Enrollment among informal-sector workers remains limited, with activity concentrated primarily in Lagos and Abuja. Paul-Ozieh identified several systemic barriers hindering progress. These include delayed claims payments, provider tariffs that do not reflect current economic conditions, and negative attitudes among some enrollees. She also highlighted the exclusion of certain healthcare professionals from insurance programs as a significant issue. As providers, her organization faces difficulties when diverse professionals are not included in the provision of health services under the insurance scheme. She called for stronger collaboration between the government and private healthcare entities to build sustainable community-based schemes. A central part of the proposal involves the role of community pharmacies. Opara argued that pharmacies are often the first point of contact for Nigerians seeking care for common ailments, rather than hospitals or primary healthcare centers. Integrating these facilities into insurance networks could significantly broaden access. However, he stressed that pharmacies should not replace other healthcare professionals. Instead, they must operate within a coordinated system featuring clear referral pathways and defined professional responsibilities. Trust remains a major hurdle for expansion. Beneficiaries require transparent information regarding covered services, exclusions, and potential additional costs. Opara insisted that the system must offer a credible route to care when members need it most. Without such clarity, skepticism will persist. The industry leaders concluded that moving beyond simple enrollment growth requires a fundamental shift in how insurance products are designed and delivered. The participants agreed that addressing the financial realities of informal workers is essential for achieving universal health coverage. Current models often ignore the irregular nature of their income streams. By developing adaptable insurance structures, stakeholders hope to bridge the gap between policy goals and practical application. The focus remains on making insurance a functional tool for protection rather than just a statistical metric. Reactions from the floor underscored the urgency of the situation. Providers expressed frustration over tariff reviews and claim settlements. They believe that fair compensation and efficient processes are prerequisites for better service delivery. The consensus was that collaboration among regulators, insurers, and frontline staff is non-negotiable. Only through unified effort can the system translate into accessible, quality care for all Nigerians. The conference ended with a collective push for actionable policy changes. Delegates left with a shared understanding that the status quo is unsustainable. The pressure is now on federal and state authorities to respond to these specific demands. The goal is to ensure that health insurance serves its intended purpose: protecting households from the devastating cost of medical emergencies.