Table 1 Overview of the key features of the Anambra State Health Insurance Scheme

Year of establishment

ASHIA is established by the Anambra state health insurance scheme law in 2016

Officially launched and started its operation in September 2018

Scheme design and management

Operates a single pool system

Premium contribution rate is determined by actuary where the contribution is as follows:

◦ Equity fund established for the vulnerable persons and

◦ Earnings-related to the public (State & LGA) and organized private sector (OPS) employees

For the public sector, an employer pays 10% while employee contributes 5% of the basic salary. However, for employees of the organized private sector, the employer may decide to pay the entire contribution for the employees

Contribution of an annual premium of twelve thousand Naira (N12,000) (24USD) per person, for individuals who are not in a formal employment

Co-payment of only 10% of the cost of medications prescribed to an enrollee whether as outpatient or inpatient services made to the health care providers (HCPs) at the point of care

Anambra State Health Insurance Agency (ASHIA) regulates/manages the scheme and acts as sole purchasers

Health insurance model

Prepayment system of healthcare financing

Enrolment

Premium cover healthcare benefits for the employee, a spouse and four (4) children below the age of 21 years for formal sector employees

However, children above 21 years will be covered through the OPS or private insurance

Eligibility

All Anambra indigenes are eligible to enroll in the scheme

Source of funds

Financed through premium (social security, payroll taxes, and private contributions); government subsidy (general, earmarked taxes, and non-tax revenues), and other sources (donations/philanthropy, donor funds, Basic Health Care Provision Fund)

Benefit package

Covers basic package of services including health promotion, disease prevention, curative and rehabilitative health care services provided at the primary and secondary levels of care

Provider payment mechanism (PPM)

Capitation and fee-for-service (FFS) model

Capitation is for primary healthcare while FFS is for secondary and tertiary healthcare

Purchasing

Done by ASHIA

Selective contracting

Services are provided by accredited private and public health facilities or HCPs across the state

Community involvement in scheme design and management

Feedback given at monthly and quarterly review meetings (comprising clients/enrollees, HCPS and ASHIA staff) and is used to improve the scheme design and service delivery