EVALUATING A HEALTH INSURANCE SCHEME IN A HOSPITAL SETTING: PROPOSING AN ALTERNATIVE TO OUT-OF-POCKET PAYMENTS IN NIGERIA.

Background: Mental health care in Nigeria relies heavily on out-of-pocket payments, creating financial barriers that hinder access. A pilot scheme linked to the National Health Insurance Authority (NHIA) Group, the Individual and Family Social Health Insurance Program (GIFSHIP) was initiated to alleviate these challenges.

Objective: The study sought to assess the NHIA scheme's effectiveness in reducing costs, enhancing clinical outcomes, and improving patient satisfaction relative to traditional payment methods in mental health care, while also evaluating the feasibility of a pilot individual GIFSHIP.

Methodology: The study examined the NHIA scheme over nine months at a tertiary mental health facility in Nigeria, involving patients with various mental health diagnoses eligible for insurance. Data on care costs, in-patient admission rates, and patient satisfaction were gathered through structured questionnaires and hospital records. A comparative analysis was performed between insured and non-insured patients.

Results: Insured patients experienced a significant reduction in financial burden, with monthly out-of-pocket expenses approximately 40% lower than their non-insured counterparts. In-patient admission rates and patient satisfaction were similar across both groups. The hospital's indigent patient fund supported a pilot individual GIFSHIP program for individuals with mental illness. Anticipated cost benefits may enhance service uptake and revenue for the hospital.

Conclusion: The pilot mental health GIFSHIP scheme may alleviate financial pressures on patients and enhance access to quality care. Policymakers and healthcare providers can advocate for similar insurance schemes, particularly in integrated care environments, to foster sustainable and equitable mental health care for all. Keywords: Mental health insurance, GIFSHIP, Nigeria, out-of-pocket payment.