Yusuf: How corruption, inefficiency, political interference kill health insurance programme

The National Health Insurance Scheme (NHIS) has failed in meeting its mandate of providing cheap and accessible health care to all Nigerians through a pre-payment method due to corrupt practices, inefficiency and political interference.

Eleven years after the inauguration of the scheme by former President Olusegun Obasanjo, it is estimated that only four per cent of Nigerians, especially those in the formal sector have health insurance.

New Executive Secretary of NHIS, Prof. Usman Yusuf, in a maiden meeting with the Health Maintenance Organisations (HMOs) in Abuja, last week accused the latter of defrauding and owing scheme and the primary care providers to the tune of billions of naira (N90 billion) even as he threatened to delist defaulting companies.

Yusuf also accused the HMOs of criminal negligence. He said despite the fact that the NHIS releases funds, three months ahead, for the payment of the retainer hospitals where the enrollees are attended to; most the HMOs do not pay the capitation to the hospitals. He, however, said the situation is critical since 90 per cent of Nigerian hospitals depend on the capitation to survive.

HMOs are organisations registered with the NHIS that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities and acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis.

Capitation is a payment arrangement for health care service providers such as physicians or nurse practitioners.

Yusuf said that many health care providers have caused deaths and sufferings to the enrollees after taking their money and treating them as lepers.

The NHIS boss likened the corruption in health financing to that with fuel subsidy. “There is no healthcare financing in Nigeria but ‘healthcare subsidy. HMOs have corrupted healthcare financing system in Nigeria,” he said.

To address the situation and reposition NHIS towards universal coverage, Yusuf plans to have a retreat with all NHIS and other stakeholders in Kaduna from August 31 to September 3, 2016, and to set up robust Information Communication Technology (ICT) to help monitor players and ensure accountability.

Yusuf made a strong statement: “A new Sheriff is town. It is not going to be business as usual.”

Yusuf told the gathering: “The mandate of Mr. President is crystal clear. ‘Go and make NHIS work for all.’ We must make NHIS work for all Nigerians. We cannot do that unless we look at ourselves. We failed because of corruption, inefficiency and political interference. Politicians look at money in NHIS as ATM. It is not their money. It is not our money. It belongs to the enrollees.

“Let us chart a path forward for this organisation that we will all be proud of. You guys have been sleeping on duty and just dishing out money. I will be fair, just but I will be firm. I will reward hard work, but have zero tolerance for gossip.

“I have the law behind me, I have the financial support and the goodwill of the presidency. I will chart a path that we will all be proud of. I will be a good shepherd of people’s common wealth that I have been entrusted with. It is going to be a good dawn.

“Nobody is thinking of the enrollee whose money it is. We are all partners but you have to obey the rules. We are not regulating the HMOs and they are salivating. They want a piece of the action. The politicians are seeing us as ATM. If we continue this way, we will continue to fail.”

How have the stakeholders in the health insurance programme fared in 11 years? Yusuf said since the criteria if the number of enrollees, all have failed because “|we have not added more enrollees.” He said the Nigerian Labour Congress (NLC) is the only good group in the equation because it is the only one fighting for the enrollees.

Yusuf threatened to delist the HMOs. “We give you money and you put it in your pocket and you don’t give the money to the primary providers. I can do without you. We give you money months before. HMOs in the United States (U.S.) go out to the field and get enrollees enlisted and are paid according to their work. Here you have not earned what we paid you and you want some more.

“I have the list of all the HMOs owing us or owing the providers. You have to pay us in full. If you don’t you will be made to. I have directed my legal department to pull out letters to the defaulting companies.

“The regulator is being dictated to by the regulated. We are the Central Bank of healthcare in Nigeria. So you are not going to get the money. We will hold it, we will regulate it and we will enforce the rules.

“Many health care providers have caused deaths and suffering because they take the money but don’t offer the services. Enrollees are treated as lepers. They are kept in one place and say ‘don’t allow this enrollee to see me.’ You have never been to the hospitals.

Yusuf decried a situation where doctors have been quiet and the HMOs are dictating healthcare financing. “Doctors should be dictating the narratives of healthcare not HMOs. The politicians are not educated on NHIS. There is no healthcare financing in Nigeria. It is healthcare subsidy,” he said.

The NHIS boss accused the HMOs of masterminding the short tenure of his predecessors: “Nobody has lasted more than five years in this office. They say the HMOs will come after you. I will have a strong enforcement unit. If you don’t pay us you will go to jail. This is a fair warning to all of us. A new Sheriff is in town. It cannot be business as usual.”