One of the aims of the National Health Insurance Scheme (NHIS), is ensuring access to good health care without financial hardship to families; limiting the rise in cost of health care services.
The NHIS is also responsible in issuing appropriate guidelines to maintain the viability of the scheme; registering HMOs; and addressing other necessary issues to achieve the objectives of the scheme.
The Chairman, Health and Managed Care Association of Nigeria, (HMCAN), Dr Babatunde Ladele, at a recent media chat, spoke on the state of health insurance in Nigeria, with particular reference to the role of the Health Maintenance Organisations (HMOs) in the schemes of things, the Health and Managed Care Association of Nigeria (HMCAN). Universally, HMOs work with “prepaid health plans in which patients are generally covered only if they use providers specified by the plan and access them according to rules established by the plan.”
He also spoke on the challenges in the health insurance scheme, way forward and how the country can advance the scheme.
What is the misunderstanding between you and NHIS?
Recently, there have been a lot of flacks about what we do. In clarifying things, the HMOs are creation of an act parliament of government. We are registered with CAC to maintain the people’s health. We have been on ground for about 20 years.
The new Executive Secretary, Nigeria Health Insurance Scheme (NHIS), Dr. Usman Yusuf is saying pre-paid scheme is a fraud and it is very important we try to correct the impression. We have been in business even before he came, lessons have been learnt in this business and it is unfortunate that we have been labelled as frauds, as scammers and all that. Why were some HMOs labelled as scam?
What informed the Executive Secretary to label some HMOs as scam was because before the advent of health insurance, there is what we call retainership system in the sense that the more you are sick, the more the hospitals get patronage. So there is a paradigm shift now, that one has to pay some amount of money through pre-paid method. If you are ill, you will go to the hospital and receive quality care and if you are not ill, your money would cross-subsidise some other people’s treatment. In other words, these HMOs are all about the place giving you health information so that this premium you have paid would be managed properly for the few who will be ill.
For example, if you look at the formal sector, they represent only five percent of the population. There is need however, to reach the vulnerable group in the society and those who are not working in the formal sector. This is where the HMOs come in, so that we can reach out to those who have and help those who don’t have.
How can the scheme cover the poor in Nigeria?
Dangote can say that in Dangote village, there are 250,000 people that are enumerated to be vulnerable and he would like to pay for their health insurance for 10 years at the rate of ten thousand naira per person, per year and these vulnerable people will start receiving health care.
The federal government was talking of some vulnerable people in Nigeria who are to receive five thousand naira. I can assure you that if I have that set of people today, let us assume that these people are like 10 million and if they can match that with some of the pool money with NHIS, we can give them a package. Those set of people can be uploaded today, but we have to get the executive power to do that.
What is then is the way forward?
The way forward is for someone who is in the health insurance to man the affairs of the NHIS. For example, Emefiele of central bank, was Managing Director(MD) of Zenith Bank, Sanusi was also the MD of First Bank, so why can’t someone who have been on ground for 20 years man the affairs of the NHIS?
The new Executive Secretary has been there for like 6 months and he has not grown the scheme by one person and nobody is asking questions. He kept complaining that HMOs are the problem, that if he has his way, they should have been removed because they are just taking our money.
Meanwhile, every problem we have in the NHIS in setting of the scheme in Nigeria has been failure of regulation. The regulator wants to be the operators, the regulator wants to register HMOs, to register enrolees, but the law did not state that. The law is very clear that the HMOs should be the keeper of the premium collected as it is in the insurance industry and the banking sector.
The Federal Ministry of health as a supervisory ministry has not been effective either in doing the needful at NHIS. For example, if it is not appropriate for the Executive Secretary not to spend more than N2 million and he is spending more than that and then, nobody is asking question.
There is no council in place at the NHIS. It is the duty of the council to make decisions, give direction on the day to day running of the place through the Executive Secretary and then things can start working properly, but we have a sole administrator who can just wake up one day and decide on what to do without anybody monitoring him.
We are supposed to be pre-paid for three months and we are supposed to be pre-paid , two weeks to the coming month. As I speak to you, we are just being paid the month of February. This money has been taken since December from Treasury Single Account (TSA), kept somewhere, and we are just being paid in February.
The major gap in the NHIS is that there is no council. If we have a council, there are going to be different interest, and we will have a chairman, so if there is a council that is overseeing the Executive Secretary, as a check on his activities, the scheme would be run smoothly. So that is a very big gap. A board should be inaugurated.
And if there is a council, it will not affect the work of the ministry, the act is very clear on that. The act states that the council directs the day to day running of the NHIS through the Executive Secretary and may take instructions from the federal ministry of health.
By: Doris Obinna
The Sun News
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