NHIS, stakeholders decry poor performances of HMOs

Stakeholders in the health sector has said that the inefficiencies and poor services meted on patients by some Health Management Organization (HMOs) may truncate the realization of full success of the National Insurance Scheme (NHIS) in Nigeria.

They said apart from high costs, charges and poor dispensation of drugs to patients, only one out of 57 Health Management Organizations had fully met the criteria for accreditation, a situation that has put fears in the minds of the HMOs to perform maximally.

The NHIS is a body set up by decree (Act 35) of 1999 operating as public private partnership and directed at providing accessible, affordable and qualitative healthcare for all Nigerians.

Mr. John Iruse, a civil servant with the ministry of finance told journalists yesterday in Abuja that majority of the civil servants registered with some of the Health Management Organization (HMOs) are frequently treated shabbily anytime they go for treatments.

Iruse said, “We are often denied of quality drugs and we are heavily billed. This is painful more so that deductions are taken from our monthly salaries for this purpose. What is more worrisome now is that we hear every now and then that even when our MDAs deduct, such funds are not remitted to the HMOs as at when due.”

In his speech recently to the Lunch Time Reforms Seminar Series organized by the Bureau of Public Service Reforms (BPSR) in Abuja, the Acting Director-General of the BPSR, Dasuki Arabi said that government is aware of complaints regarding to challenges facing the HMOs hence it has started working hard to strengthen the National Health Sector in order to meet the challenges of the Nigerian Public in the health service delivery system.

Arabi explained, ‘’For instance, the Health Insurance scheme, which is basically a social security system that guarantees the provision of the needed health services to persons on the payment of a token contributions at regular intervals, where the insured pays costs cu-of-pocket and is then reimbursed by the insurer’’.

According to him, as part of the various studies carried out by the BPSR research, we conducted a study on waiting time to see a Doctor in Public Hospital with the aim of improving the process of accesses to health care in Nigeria; policy briefs on this study have been submitted to the federal executive council.

Speaking on the topic, ‘’The Role of health Management Organization (HMOs) in the successful implementation of the NHIS, the Chairman Senate Committee on Public Service, Usman Yusuf gave categorized registration and payments of HMOs formula thus ‘’a National HMO shall be required to have a fully paid up share capital of N400million and subject to review by the NHIS, a zonal HMO shall be required to have a fully paid up share capital of N200million and subject to review by the NHIs and that a State HMO shall be required to have a minimum paid up share capital of N100million and subject to review by the NHIS’’ respectively.

Represented by a Senior Officer in the NHIS, Mrs. Joke Balogun, Yusuf said that the roles of the HMOs cannot be overemphasized as they includes, that of collecting contributions from registered employers and employees under the private health, insurance, where applicable, ensure timely payment of capitation to primary facilities and fee-for-service to secondary and tertiary facilities, ensure effective processing of claims (secondary services), return unpaid capitation and fee-for service payment within 30 days of the following month to the Scheme as well as collection and submission of encounter data forms from HCFs to NHIS among others.