On the Unintended Impact of Health Insurance
By Oladoja M.O
Encouraging is an understatement when you consider how far we’ve come in health insurance coverage in Nigeria. It’s pleasing to see health insurance gradually becoming a bigger part of Nigeria’s healthcare conversation. More people enrolling, more attention to coverage, and the ongoing expansion and adjustment of health insurance programmes all point in one direction: we are taking financial protection in healthcare more seriously.
For a country where illness can quickly become a financial crisis, this is certainly worth celebrating.
But while we celebrate the numbers, we should also ask: what happens when the insured person actually walks into a hospital?
There appears to be an emerging culture around insured patients that we should not allow to become normal.
You hear it in the phrase, “they are under HMO.”
Some patients have experienced delayed attention, dismissive attitudes and poor communication simply because their care is being financed through insurance. There are stories of patients being made to feel like a burden because someone else, rather than the patient standing in front of the provider, is paying the bill.
A social media post that circulated recently brought this into the open. Someone associated with a healthcare facility made a derogatory remark about a family who had come to receive care under health insurance.
The concern isn’t just the statement, but the thought of what those people and many others may have experienced before that statement ever appeared online, and the comments under the post so proved a lot that people had been put through.
That was the one that became public.
How many others never do? An this is where health insurance meets something much deeper in our society: classism.
We already know that the ability to pay can influence how people experience healthcare. Health insurance is meant reduce that inequality, not create another label through which patients are treated differently.
And to note, quality of care is not just about eventually receiving treatment. It includes how the patient is received, how long they wait, how they are spoken to and whether they retain their dignity while receiving care.
Hearing from both sides, healthcare providers do have legitimate concerns about the economics of health insurance. Tariffs vs actual treatment cost, uncertainty of reimbursement, etc., factually, running a healthcare facility is expensive, and particularly for private providers, sustainability cannot be ignored.
But while these are legitimate concern, it is a big problem when the gap is pushed down to the patient.
There are concerns about patients being asked to make additional payments even when the service is covered by their insurance, attempts to recover inadequate reimbursement through duplicating charges or claiming for services a patient did not actually receive, and patients routinely being asked to pay part of the cost even when the treatment falls within their insurance coverage.
Yes, this is not to indict healthcare providers, but we can all agree that these concerns are too important to ignore.
When the provider and insurer disagree about the cost of care, the patient should not quietly become the person who settles the disagreement.
I remember asking a question during a session at the maiden African Primary Health Care Forum in 2025, that how do we balance healthcare provision with the intention to make profit, without allowing profit to override the people who should remain at the centre?
Unfortunately, there was no easy answer. Truthfully, it is tricky.
Providers need to survive, insurers need to remain financially sustainable and government cannot carry every cost in the health system. Yet somewhere between these competing interests is the person who became sick in the first place.
This is why the response cannot simply be “let’s increase the tariffs” or “let providers absorb the loss.” Neither is sustainable. If tariffs rise without considering the wider financing burden, patients may eventually bear the cost. If providers continually operate below sustainable levels, quality of care will suffer.
And that’s why there’s need for a dive at whole financing structure.
The government needs to examine the real costs and obligations of healthcare provision and identify where targeted fiscal relief or support can ease pressure on providers without simply shifting it to patients. Insurers must reimburse realistically. Providers must be allowed to remain viable, but must also remain accountable for what they provide and claim.
Monitoring must become active!
Where systems have gaps, people will eventually find ways to exploit them. Claims should be monitored. Unusual billing patterns should raise questions. Services billed should correspond with services delivered. Patient complaints should not disappear into administrative files, and repeated non-compliance should have consequences.
This is not about setting providers against insurers. Everyone has a part to play.
The government must regulate and create an environment where healthcare financing is sustainable. Insurers must protect the integrity of the pool and pay fairly. Providers must deliver quality care without making patients pay for every weakness in the system. Patients must also understand their rights and speak up when something is wrong.
The point is not to remove profit from healthcare. That is neither realistic nor desirable. The point is to ensure that profit does not become more important than the person healthcare is supposed to serve.
That is the balance we need.
Because ultimately, the success of health insurance should not be measured only by how many people have been enrolled.
It should also ask what those people experience when they finally need care, if the insurance actually protects them, if they can walk into a facility without being treated as a lesser patient because they are “under HMO”, if they receive the care they are entitled to without becoming the financial solution to a disagreement between provider and insurer?
Expansion of health insurance in Nigeria must weigh in on these questions.
We are still building this system, and that gives us an opportunity to correct what is beginning to go wrong before it becomes normal.
Health insurance is too important to lose the very person it was created to protect.
The patient must remain at the centre, not at the receiving end of the system.
And the unintended negative stretches of this beautiful system must be confronted and, while we still can, nip in the bud.
Oladoja M.O. (Oladoja Mark Olamilekan) writes from Abuja and can be reached at: mayokunmark@gmail.com.
