FG Raises Health Insurance Payout to ₦1,450, Introduces Referral Code for Faster Patient Care

The Federal Government has announced a major upgrade in Nigeria’s healthcare financing system with the increase of the national health insurance capitation fee from ₦750 to ₦1,450 per enrollee.

According to Ali Pate, the Coordinating Minister of Health and Social Welfare, this adjustment is designed to strengthen access to affordable medical services and ensure higher quality care across the country.

Pate explained that the decision aligns with President Bola Tinubu’s Renewed Hope Agenda, which aims to achieve Universal Health Coverage (UHC) by the year 2030.

Higher Payment Rates for Better Medical Services

The minister revealed that apart from the increase in the capitation fee, fee-for-service rates have also been reviewed upward by 380%, reflecting current economic realities and the rising cost of healthcare delivery in Nigeria.

“For years, the capitation fee stood at ₦750 per person. We have now raised it to ₦1,450 to enable hospitals and clinics to deliver consistent, quality medical care,” Pate said.

He added that the upward review is based on actuarial evidence, ensuring that new payments reflect realistic service costs and promote sustainable healthcare financing.

Over 20 Million Nigerians Now Covered by Health Insurance

The Coordinating Minister noted that more Nigerians are embracing the national health insurance scheme, with over 2.4 million new enrollees added in 2024, bringing the total number of insured citizens to about 20 million.

The government’s target, he said, is to expand coverage to 44 million Nigerians by 2030.

To support this growth, nearly 120,000 health workers have been trained since 2023, while 2,500 doctors, nurses, midwives, and community health workers have been recruited to improve frontline healthcare delivery.

Additionally, about 4,000 medical personnel have been deployed to federal tertiary hospitals to address manpower shortages in critical departments.

Reducing Out-of-Pocket Spending for Nigerians

Pate emphasized that out-of-pocket expenses still account for nearly 70% of total health spending in Nigeria, a figure the government aims to reduce through broader insurance coverage.

“Expanding health insurance is the most effective way to lower financial stress on Nigerian families and ensure no one is denied treatment because of cost,” he stated.

Patient Referral Code to Speed Up Treatment

To improve efficiency and reduce patient delays, the government has introduced a one-hour referral authorization code.

This new system is designed to ensure that patients can move seamlessly from primary to specialist care without unnecessary waiting time.

The Minister also directed the National Health Insurance Authority (NHIA) to begin covert monitoring (mystery shopping) to track healthcare providers and prevent cases where registered patients are denied treatment or experience poor service delivery.

Ongoing Healthcare Reforms Gaining Public Confidence

Pate reaffirmed that ongoing reforms under the Basic Health Care Provision Fund (BHCPF) and the National Health Insurance Authority (NHIA) are already improving public confidence in the healthcare system.

According to him, these reforms are key to building a sustainable national health financing structure that guarantees every Nigerian access to affordable, quality healthcare.

What This Means for Nigerians

The increase in the health insurance payout and service rates will likely boost hospital capacity, improve patient satisfaction, and attract more private sector participation in healthcare financing.

For millions of low-income families, it means reduced medical bills, better access to doctors, and quicker treatment through the new referral code system.