Health care is known as one of man's fundamental needs. The cost of health care has been on the rise for decades now owing to increasing population, increased life expectancy, rise in cost of hospital equipments amongst other things. Skyrocketing cost of healthcare, the effect it has on families and communities brought about the concept of universal health care.
Eye care, a microcosm of the health care concept, comprises the primary eye care, the secondary eye care and tertiary eye care systems. The eye health care concept is fundamental to a healthy eye and by extension to a healthy body.
WHO (2012) estimates there are approximately 314 million people around the world whose vision is impaired, due either to eye diseases or uncorrected refractive errors. Of this number, 45 million people are blind and over 110 million in need of low vision aid.
The direct and indirect cost of visual impairments and blindness to the society and especially to the individual runs into hundreds of million dollars. The direct cost is measurable via cost of performing eye surgery, cost of having a comprehensive eye examination, the dearth of eye care professionals and eye care structures etc. Indirect cost is measurable by measuring the activity of daily living quotient.
Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, is a health care system which provides health care and financial protection to all its citizens. universal health care system incorporates the primary health care system that focuses mainly on prevention, early detection and planned management of diseases or illnesses.
The concept of secondary health care, which includes active use of medication to manage diseases, illness and or injuries, the use of surgery to remove, replace or amend tissues or organs. And tertiary health care system, this health care system is focused on rehabilitative care e.g. low vision care etc.
Historically, Germany is credited as the first country to start up a universal health coverage for its citizens as early as 1883! As at 2009, we had about 58 countries with one form of Universal health care or another. {1}
Nigeria is eager to achieve Universal Healthcare Care. Since its launch in 1999, the National Health Insurance Scheme (NHIS) has been the major initiative to expand health insurance in Nigeria. However, as of mid-2012, NHIS still covered only about 3 percent of the population (5 million individuals). {2}
There are four models of health care systems as put forward by Physicians for a National Health Program (PNHP), Chicago (2010). {3}
I will discuss them briefly:
a) The Beveridge Model: In this system, health care is provided and financed by the government through tax revenues of the government. This is known as the single payer model of health care system. This means that the government determines what type of health care services is been provided for the individual, what the doctors will charge and the individual is not expected to pay for his health care services! The government acts as both the regulator of funds and regulator of health services provided. This model is named after the author, William Beveridge.
Countries practicing such model include Britain, Cuba, Spain, most of Scandinavia, New Zealand and Hong-Kong.
b) The Bismarck Model: This model of health care system is regulated by government, financed through payroll deductions from employees and employers of labour known as health insurance fund. It is often a no-profit insurance scheme and it is aimed at providing health care coverage for everyone. This is a multi-payer system of health system and named after the Prussian Chancellor Otto Von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Countries that practice this model include Germany, France, Belgium, Japan, Netherlands, the USA( though it practices a variant kind!) and to an extent Latin America.
c) National Health Insurance (NHI) Model: This model adopts the Beveridge and Bismarck systems of health care provision. Government-run insurance scheme are paid into by the citizens and the government on its own provides fund via taxation to fund the NHI model. Government regulations control how the health fund is used both in private and public health care facilities. Countries that practice this system include Taiwan, Canada and Nigeria.
d) Out-of-Pocket Model: This model requires payment from the pocket when the patient goes to see a doctor. This is common in many rural areas in Africa, Asia etc were health care facilities are either moribund or health care facilities are not readily in place.
Majority of Nigerians and Africans practices the out-of-pocket model till date, the remaining minority especially those working in state, federal civil services and those working in banks, multinational companies etc are covered under the NHI Model and/or the Bismarck Model of health care!
No doubt that health insurance scheme is cost effective, but enormous challenges abound as to the effective implementation of this scheme in the country partly as a result of inadequate legislation, corruption and outright distrust of the portfolio handlers, the government. These are some hitches that frustrate the effective take-off of the scheme in Nigeria since it was made law in 1990 . The 2014 National Health Bill passed by President Goodluck Jonathan last year can be said to have put to rest a lot of the challenges raised above. We are looking forward to a more participatory health insurance scheme in the country when the policies in the bill are implemented from the second quarter of 2015.
How does eye health care service benefit from NHIS scheme in Nigeria? Of what effect is the National Health Bill of 2014 to the rising cost of eye care services in Nigeria today? How will NHIS bill affect the direct and indirect cost of visual impairment and to blindness in the country? How do the eye care professionals key into National health insurance scheme? Legislatively, can the eye care business be said to have a better representation in the 2014 National Health Bill 2014? I will discuss the questions raised above above in a subsequent blog while analyzing them in the light of WHO's requirements for achieving Universal health care goals, they include:
1) A strong, efficient, well-run health system.
2) A system for financing health services.
3) Access to essential medicines and technologies.
4) A sufficient capacity of well-trained, motivated health workers.
To be continued...
