HMCAN, HCPAN set up joint committee to self-regulate health insurance in Nigeria

In the bid to reduce out-of-pocket payments and enhance universal health coverage (UHC) with health insurance, the Health and Managed Care Association of Nigeria (HMCAN) and Healthcare Providers Association of Nigeria (HCPAN) have set up a joint committee to self-regulate, set standards and instill high ethical and professional discipline for all stakeholders in the healthcare services and health insurance industry.

HMCAN is the umbrella association of National Health Insurance Scheme (NHIS)- accredited Health Maintenance Organisations (HMOs) in the country and HCPAN is the umbrella association of NHIS-accredited health care providers.

Chairman of HMCAN, Dr. Kolawale Owoka and President, HCPAN, Dr. Umar Sanda at the occasion of their bilateral co operation in Lagos said part of the terms of reference of this joint committee was to enforce compliance with the set standards for all accredited health maintenance organizations and all accredited health care providers across the country whether the HMO or the health care provider is a member of either of the association or not.

Owoka told journalists: “In order to sanitise the healthcare industry and begin to drive towards the attainment of universal health coverage, it was unanimously agreed that only HMCAN and HCPAN members should be allowed to actively participate in the running of health insurance programme in Nigeria as this will eliminate the provision of poor healthcare services, enhance prompt and regular settlement of medical bills by health management organization and also arbitrate on dispute with the outcomes communicated to the concerned parties and the NHIS, the regulator for notification and possible sanction.

“Part of the deliverables of the joint committee is to foster mutually rewarding, cordial and unity amongst stakeholders, regularly resolve all issues of unethical and professional misconduct that may arise from any healthcare provider and health maintenance organizations and cascade the outcomes to the regulator.”

Sanda said the committee would also anchor regular joint industry engagement by all stakeholders, pursue legislative mandate to make health insurance mandatory and embank on joint public enlightenment in conjunction with the NHIS to create top-of-mind awareness for the health insurance scheme.
Owoka said the committee, however, encourages all enrollees, health care providers and health maintenance organizations with genuine cases of infraction to send their petition to the committee for prompt adjudication. The petition, he said, should be addressed to the Chairman of the committee and sent to the HMCAN Secretariat in Lagos.

The group at the occasion of their bilateral co operation said making healthcare insurance compulsory would not only reduce the high percentage of out of pocket payment, but it would as well ensure sustainability of the healthcare system across the country.
Owoka and Sanda at the event jointly agreed on the usage of capitation as the minimum that would be acceptable from any HMO for all private health insurance.

They further affirmed that only registered members of both groups would be allowed to operate in the NHIS and its benefit package as well as premium usage. Both of them also assured that self regulation and high ethical standards would be instilled among members. “All discriminating activities at the point of services delivery would be reported and investigated.’’

Secretary of HMCAN, Mr. LekanEwenla,said that the ultimate concern of major stakeholders in the healthcare industry is to guarantee quality and affordable care to the average person.

“It has been seen globally that the best way to go is to actively engage the private sector or investors in the running of healthcare,” Ewenla remarked.
He tappealed to government to regulate and create the opportunity for the private sector to drive the health insurance because it seem the only way for Nigerians to access quality healthcare through the scheme.

“The scheme is meant to address the issues of Nigerians paying out of pocket for healthcare. If you are paying out of pocket it can take you from above the poverty level to below the poverty level, and that is responsible for the death of quite a lot of people,” Ewenla added.

He also said the essence of doing all of this is to identify the key challenges that will hinder working together harmoniously and mitigate not achieving the desired objective.

The HMCAN secretary advanced: “We have seen all the challenges and the essence of coming together is to gradually and collectively convert those challenges to opportunity for everybody. Nigerians are the only ones that can develop this country.”
“We are already working with the NHIS,” Ewenla noted. “But we are trying to further enhance our responsibilities to take ownership of the industry and begin to drive it the way it ought to be driven for the benefit of all.”

He noted that though it is governments’ business to regulate businesses and create an enabling environment for private investors to thrive, “but they cannot run the scheme, as it is not their dealing to do business and that have been seen globally.”

Ewenla urged government to have a second look at the law establishing the scheme in other to make it compulsory, because anywhere results are achieved there is a strong regulatory apparatus in place to ensure compliance. Once that is achieved, everybody would fall in line.
“A healthy nation is a wealthy one, so we need to take care of the health needs of the people and also make it affordable,” he stated.