Optimal Design of Nigeria’s National Health Insurance Benefit Package Using Actuarial Cost-Effectiveness Analysis

This study develops an actuarial cost-effectiveness analysis framework for optimal health insurance benefit package design under Nigeria's universal health coverage framework, contributing an original decision-theoretic approach to health insurance benefit design that integrates actuarial pricing constraints with public health priority evidence. The National Health Insurance Authority Act 2022 requires NHIA to define a comprehensive benefit package for universal coverage, but the actuarial and public health methodologies for making evidence-based benefit inclusion decisions under budget constraints are not well-established in the Nigerian policy literature. This study proposes a maximum expected health benefit per naira of insurance cost framework that combines actuarial cost modelling with WHO-recommended cost-effectiveness thresholds adapted for Nigeria's income level. The framework is applied to a candidate list of 120 health interventions proposed for inclusion in the NHIA basic benefit package, using disease burden data from the Nigeria Burden of Disease Study, intervention effectiveness evidence from systematic reviews, and unit cost estimates from the Federal Ministry of Health cost accounting database. Actuarial premium implications of alternative benefit packages are computed under demographic and utilization projections. Findings identify a cost-efficient core benefit package of 73 interventions that delivers 89 percent of the maximum achievable health benefit from the candidate list at a per capita premium of approximately 12,000 naira per year, within the feasible public finance envelope. The study contributes an original actuarial benefit design framework for Nigeria and recommends its adoption as the evidence base for NHIA benefit package development.

Keywords: benefit package design, health insurance, cost-effectiveness, NHIA, universal health coverage.