International Best Practices in Health Insurance Regulation

Abstract

Effective regulation of the health insurance market is important in order to check those stakeholder behaviours and practices that lead to  market failure that will make it difficult for the system to truly guarantee financial risk protection and optimal health outcomes for enrollees. This paper is a normative attempt to provide a menu of regulatory approaches considered to have the potential to promote a  well-functioning health insurance industry in Nigeria with application in countries at similar stage of health systems development.

Experiences from different country health insurance regulatory environments were highlighted using information from grey literature.  Official documents relating to the establishment and operations of Nigeria’s National Health Insurance Scheme (NHIS) as well as  Nigeria’s health financing and health policy documents were also reviewed. Additionally, author’s experiences in participating in  Nigeria’s health sector reform programme over more than a decade ago were also brought to bear on the topic. The article is  substantially derived from a paper the author presented at a health insurance strategic policy and practice dialogue organized in 2014 in  Lagos Nigeria by the Lagos Chamber of Commerce and Industries (LCCI).

Health insurance regulation derives substantially from the law  establishing the country’s health insurance in which the roles and responsibilities of stakeholders involved in the operation of the health  insurance market are clarified. Nevertheless, it will appear somewhat difficult to prescribe any generic set of global best practices for the  regulation of the insurance industry anywhere, given the heterogeneity of country situations and contexts. Rather, some critical success  factors that stand a chance to promote effective and sustainable regulation of the health insurance industry are recommended here. One  of such factors include the position that a country’s health insurance regulatory agency ought to be run as a specialized  government’s agency with personnel that does not have to come from the civil service bureaucracy.

All considered, there is no ‘iron-cast’  template for international best practices in health insurance regulation as each country needs to adopt measures that fit its contexts and  peculiarities