Commissioner for Health Professor Akin Abayomi has asserted that Lagos State will soon begin enforcing compulsory health insurance as the government seeks to ease pressure on public hospitals and improve access to healthcare,

Speaking during an interview with ARISE NEWS on Friday, Abayomi said the move was necessary as rising healthcare costs push more residents from private hospitals into the public health system, which is already dealing with an influx of patients and a shortage of healthcare workers.

“Now we’re moving into enforcement. So very soon, it’s just like if you have a car. You need three things. You need a licence, you need an MOT, and you need insurance. If you don’t have it, somewhere along the line, someone will enforce it.”

He said Lagos domesticated the National Health Insurance Authority Act through an executive order in July 2024, making health insurance compulsory for people living and working in the state. “Lagos was quick because of what you just described. Within a year or two, we had domesticated that law in July of 2024. That’s two years ago, in Mr. Governor’s executive order, essentially enforcing compulsory insurance on negotiations.”

Abayomi said the state is restructuring its health insurance system. “We’re restructuring. We’re doing a lot of enforcement. We’re doing a lot of public health awareness. We’re doing a lot of educating the public around the need for insurance.”

He said the government wants every resident to have at least a basic social health insurance package. “So everybody should have at least a social health insurance basic minimum service of package cover. And then in the private sector, we’re incorporating them into that narrative so that if you have private insurance, you at least have the basic minimum package.”

Abayomi explained that the government was also restructuring the insurance tiers to make the system easier to operate. “And that we’ve now restructured the tiers so that there is a cleaner operation of insurance in the state.”

The commissioner said the growing pressure on Lagos hospitals is linked to the rising cost of healthcare. “While the cost of care is going up, the ability to buy that care is relatively stagnant.”

He said the situation was pushing residents towards public hospitals and, in some cases, informal healthcare providers. “So the public are shifting from the private sector to the public sector and from the public sector to the informal sector, where they can walk into a pharmacist or stop the hawker on the road and tell them, I have a headache or I have a fever, and they get access to medication without going through the orthodox system.”

Abayomi said the pressure on public facilities had increased sharply. “In the last six months, our outpatient patronage has doubled in our public health facilities, Lasuthi, Korodu, Lagos Island.”

“I’ve seen thousands of patients a day. Now, you can’t imagine that kind of patronage in a private hospital.”

Abayomi highlighted the scale of pressure on healthcare workers. “Our doctors and our healthcare professionals are under a lot of stress. You can imagine with the brain drain, with this influx of patients.”

He said the shortage of healthcare workers had made the workload particularly difficult for those remaining in the system. “You know, if you work from 8 till 12, I don’t know what your time on stage is, but in the medical facility, can you imagine if they asked you to work from 6 in the morning to tomorrow 6 in the morning? It would be crazy.”

“It all boils down to healthcare financing. It boils down to demand financing, the ability to finance the purchase of your care.”

He said expanding health insurance would bring more money into the healthcare system. “Health insurance does many things. It reduces the risk. It causes a cross-subsidy and social solidarity. It takes a lot of the burden away from government so that the private sector can flourish in a health system.”

He linked the shortage of health workers to the wider economics of healthcare and said improving residents’ ability to pay for treatment could help address the problem. “Now when that happens, it will start to slow down brain drain because brain drain is an economic narrative.”

“If we fix the demand-side financing, then funds will flow. If the public, if the business people in Lagos suddenly see that Lagotians have purchasing power for health care, they will fix the supply-side.”

The commissioner also defended the level of government subsidy in public hospitals, saying the state pays for staff. “The public health service is extremely subsidised. We build the hospitals. We pay 20,000 staff. We’re the biggest ministry in Lagos state government. We repair facilities. We buy equipment. We’re constantly paying for training. We’re paying for administration, overheads, power.”

He said the state’s public hospitals generally charge less than half the amount charged by private facilities because of the government subsidy. “So they generally charge a range of something less than 50% of what private sector charges. Health is doing actually quite well.”

When asked about budget implementation. We’re above 90 percent.”

Abayomi addressed complaints about payment systems, allegations of corruption and reports of patients being asked for cash before receiving treatment. “We’ve now outsourced the payment gateways to the private sector so that it doesn’t mess up with clinical activities. So we engage payment collectors, and they are in all our facilities, and they collect the due charges that the patients have experienced within the facilities.”

He said several companies operate the payment gateways rather than a single provider.

“They’re different, yeah, and they’re different pay gateways.”

On the widely discussed case involving a woman and her daughter at a Lagos hospital, Abayomi said. “Whenever we get all the complaints in the Ministry of Health, there’s no complaint in Lagos that doesn’t reach my desk, and we take them all very, very seriously, and we investigate.”

He said the patient had arrived in Lagos after receiving treatment in another state and was initially treated through the government’s social safety nets because she had no money or family support with her. “Now she came on her own, no parents, no family, nobody, no money. So our social systems kicked in immediately, because it’s a life-saving situation.”

Abayomi said the patient underwent major surgery and received further support when she returned for follow-up treatment. “This young lady had a major life-saving surgical operation. She spent four or five days in hospital, and she was discharged well for follow-up, at cost to state, both federal and Lagos state.”

Abayomi said the government later paid for further investigations when the patient returned with another medical problem.

“The second level of social safety net kicked in, and paid for her investigation so she could have her consultations and have her treatment.”

He said the ministry’s investigation found that the reported request for cash occurred in a conversation between the patient and her mother outside the hospital, rather than between hospital officials and the family. “So she went back to her mother and said the pay facilities were not working, and that she should go outside of the hospital to get cash, so that the cash can be used to pay. None of that was a conversation that happened in the hospital. That was between the child and her mother.”

On concerns about corruption, poor service and alleged demands for money or other items before patients receive care, Abayomi said several agencies are responsible for monitoring the quality of services in public hospitals.

“We have many agencies that do the quality assurance of our hospitals. If we get these reports, we go and investigate.”

He said the state was also moving its general hospitals to a digital health information system. “We’re rolling out the smart health information platform for Lagos. So all our general hospitals are going digital. It’s going to curb these kinds of events that people are describing.”

Abayomi said the digital system would also allow patients to report problems electronically. (Arise News)