NHIS: HMOs reveal distortions that led to scheme’s predicament

The reversal of National Health Insurance Scheme (NHIS)’s role from being regulators to fund managers, as well as other distortions, are what led to the failure of the scheme to achieve its mandate.

The Health Maintainance Organisation (HMOs) under the aegis of Health and Managed Care Association of Nigeria (HMCAN), made this known recently while reacting to the on-going “misfortune” with the Scheme in recent times.

The National Chairman of the body, Dr Tunde Ladele, while speaking at a media round table in Lagos, said the scheme’s down fall began when the NHIS deviated from its regulatory duty.

“The whole mismanagement issue started when NHIS was told to warehouse the health insurance fund. Since then, NHIS objective has changed, from regulating the scheme to marketing and managing the fund. But this is not right according to the role of NHIS as stipulated by NHIS Act 35 of 1999. According to the Act, HMOs are the drivers of the scheme. They are the risk bearers while the NHIS is the regulator. It is because of this that the NHIS has lost its focus and a lot of things went wrong”, he said.

According to them, the capitation fee is meant to be prepaid but now it has become post paid. ” this is another distortion. Money meant to be paid at the beginning of the month now comes as a post payment which is why the quality of care given to enrollees are affected”, he said.

Dr Ladele noted that NHIS has failed in its duty to ensure even distribution of enrollees from the secondary and tertiary health care to the primary health care. He said;”the health insurance scheme as a social health scheme can only work if the volume of enrollees is much and it is the role of the NHIS to ensure that this is achieved”.

According to him, the non-existence of a Governing Council as stipulated by the Law establishing the Scheme has given room for more distortion to be perpetrated by the Executive Secretary making it possible for anyone occupying the position to be a boss not answerable to anyone except to itself.

“We are faced with a situation that was not created by Law in which an ES has become the sole authority to determine who is an HMO or Care Provider and even disburses more than what the Law stipulates, simply because of the gaps created by the non-existence of a governing council”, said the HMCAN Leader.

“The situation has become an aberration in which even the excesses of some Health Maintenance Organisations (HMOs) could not be punished because there is no collaboration between the Regulator and the HMO Managers”, he lamented.

Ladele urged the Federal Ministry of Health to immediately constitute the Council for the NHIS so as to restore the confidence of enrollees in the embattled Scheme.

Also speaking at the media parley, Publicity Secretary of the Scheme, Ewenla, reeled out the six-point agenda of the group which he noted had been on the burner since 2005 to include a short, medium and long term. “It’s long overdue that the National Assembly should consider upgrading the Scheme to a full-fledged National Health Insurance Commission that will give room for better regulations as well as make the Scheme mandatory for all Nigerians to buy into and operate rather than the present voluntary exercise”, said Ewenla.

Ewenla said it is only when every Nigerian regardless of their status can be covered in the Universal Health Insurance that its maximum benefits can be felt by the large population of the country.

“If the Law makes it compulsory for every employer of Labour whether in Public or Private to enrol their employees, and government also obeys the National Health Act of contributing the 1 per cent consolidated fund for those who are not covered by the formal or informal sectors, health insurance coverage would have gone a long way to reach several millions of Nigerians”, said Ewenla.

He said there was need for retirees to benefit from the scheme, as well as more coverage of diseases especially the non-communicable which is increasing by the day.

The HMO body also called for the setting up of the long abandoned ICT Platform which according to them “will ensure proper documentation and enable the NHIS, as well as the HMOs, follow and monitor the fund activities by the Health Maintenance Organisations”.

They noted that technology has made it simple to regulate a system and monitor same by removing human encumbrances “hence, it is only ideal to embrace online administration of the nation’s health insurance Scheme as soon as possible” said Ewenla.

The body also wants all premiums paid by enrollees to be warehoused with a National Health Fund situated possibly at the Central Bank to avoid undue interference and abuse by insurance administrators.

The HMCAN also welcomed the ongoing suspension and probe of the NHIS saying, it’s time Nigerians know how well their funds are managed by the Regulators.

Dr Ladele enjoined Nigerians not to lose hope in the Scheme “as it is the only means to get universal health coverage to every citizen. It is barbaric and archaic for the country to regress into the former situation where Nigerians were paying Hospital providers mostly for services not rendered under the health retainership method” said Ladele.