DISTINGUISHING AN INSURANCE SCHEME FROM A PUBLIC FUND: The Case Study of NHIMA Challenges
The fundamental difference between an insurance scheme and a public health fund lies in their scope and structure of benefits. An insurance scheme is designed to provide specific, limited coverage based on the contributions of its members. Conversely, a public health fund operates on a broader scale, aiming to provide universal health services without necessarily tying benefits to individual contributions.
THE CORE PROBLEM: UNLIMITED COVERAGE
Globally, insurance schemes are built on a delicate balance between contributions and payouts. For NHIMA, contributions are primarily sourced from formal sector employees and their employers, supplemented by voluntary contributors. However, the absence of defined limits on benefits has disrupted this balance. Members and their dependents can acc...