**Abstract**

The Nigeria health system has performed woefully against all vital health indices, trailing behind many African countries despite its enormous potentials. The reason for this is mainly due to the financial risk Nigerians face in accessing healthcare. This study addresses the implications of the current healthcare financing in Nigeria on access and equity. It shows the imperativeness of an alternative healthcare financing in line with best practices, from comparable Low- and Middle-Income Countries (LMICs), apart from the current National Health Insurance Scheme (NHIS). The findings from this study recommend that the NHIS should be strengthened through the policy reform to embrace fund pooling/risk-sharing, subsidisation for the poor and the vulnerable, mandatory enrolment, and fragmentation of NHIS. Other considerations include increasing domestic fiscal space for health and utilising a tax-based financing mechanism that has been progressive in all LMICs, thereby preventing the need for unsustainable reliance on external funding. A comprehensive package of health at the point of care is also necessary. However, all these recommendations require the government to show a commitment to improve the country's healthcare system through its health spending.

**Keywords:** universal health coverage, out-of-pocket expenditure, health insurance, health financing, health reform
