‘How we’re expanding health coverage in Bayelsa’
Four years after its inauguration, BHIS claims to have made giant strides in a field where even the National Health Insurance Scheme (NHIS) is still struggling. How did you do it?
This June will make BHIS exactly four years, because deductions commenced from June 2017, and then actual delivery of service by healthcare service providers to enrollees started on September 14, 2017. By that time, we will have another celebration. And since then, it has been a forward and upward movement, and by my assessment, it has been very satisfactory and beneficial to the enrollees. We cannot say, for the generality of Bayelsans, because you must be enrolled to participate. But by 2019, there was a need for us to review the law that established the scheme, which was initially Bayelsa Health Services Scheme. We needed to review it to be in tandem with the operations and functionality, as directed by the supervisory body, the National Health Insurance Scheme. In that new law, it made it mandatory for all residents of Bayelsa State to participate in the social health insurance scheme. You are either in the National Health Insurance Scheme or in the Bayelsa Health Insurance Scheme. Every other health insurance scheme is only supplementary. You must participate in this one. There are lots of testimonies, though we cannot say there haven’t been complaints, particularly from the enrollees, and the service providers.
Initially, there were daunting issues, and the reason is simple. We are not used to a system where we contribute ahead of when we will need the services. It was a new thing to us, and we needed a lot of patience to be able to accommodate all the problems that arose when we commenced. With time people got a better understanding of the operations, especially the operators, the healthcare providers, who are in our network, got a better understanding, better ways of utilising the funds that are paid to them. So, things started smoothening out. The few issues we have now are complaints of scarcity of drugs. That is when the enrollees go to the hospitals for treatment; drugs are not adequately given to them. These are intermittent complaints we encounter, and as a result, we hold meetings to strategise on how to perfect the scheme. There are also issues of pricing, that anytime we meet, it comes up, we come back to the office to look at reviewing the pricing and all of those things. So, it is a work in progress. We cannot say we are hundred percent done yet.
In most of the thematic areas that we are looking at, the extent of enrollment; we are supposed to cover the whole of Bayelsa State, but now, we have covered only the civil servants, and a few private sector organisations, and a few private people. So, we are not there yet, in that respect.
With regard to caregiving too, because of these complaints, they may not be things that may be completely ironed out in a flash. Consequently, efforts are geared at ensuring that these hitches are reduced to their barest minimum.
We were made to understand that the scheme covers major surgeries as well. Have you carried out such services?
The scheme is very robust, in fact, if you look at our scheme, it is almost like the fallout of the National Health Insurance Scheme, because that was the foundation upon which we built. All those mistakes that they were able to identify as they were operating, at our level, we now have to put modalities to overcome those things, and then a few of the diseases that they did not consider when they were setting up their scheme, we were able to bring them into our scheme. We do major surgeries, myomectomy, caesarian section, prostatectomy for the elderly, eye care, cataracts extraction, or any sort of eye surgery, including dental care, knee replacement. We have bought pastelis for people with diabetes, and paid for amputation for patients. We have done surgeries for multiple pregnancies and have taken care of preterm babies. Imagine someone giving birth to four kids, and all of them come as preterm. We have taken care of them, and those are very expensive medical cases, where ordinarily individuals cannot handle them at their levels. With respect to this type of medical care, the oxygen required for each of them is about N300,000. So, for each month, one would have to pay nothing less than N900,000. But since the patient is an enrollee of the scheme, the scheme foots the bill. So, at the end of the day, each of the babies may cost about N500,000, just for their preterm care, and the scheme is there to take care of all expenditure. And we have done this for several patients.
Do these people who undergo these surgeries and all others you have mentioned pay extra money?
Well, when you come into the insurance scheme, there are some of the things we call, co-payment. We introduce co-payment to certain things to curb abuse and misuse. It would also have been for drugs, but we said, okay, for the fact that we are just starting, let us leave out co-payment for drugs. There are certain cases you may be required to pay a little sum while BHIS pays the balance. Like, if you want to do a CT scan, if you want to do MAC imaging which we call Magnetic Resonance Imaging (MRI), etc., the patient pays 50 percent, and BHIS pays the remaining 50 percent. Apart from that, if it is surgeries and other medical treatments, BHIS bears full responsibility to foot the bills. Those are few things that we do not take 100 percent of the cases, and then some congenital diseases. If you give birth to children that come with congenital problems, we only do the diagnosis, we do not go into the day-to-day treatment of the children.
Apart from that, all other care is borne by the scheme. Which other services does the scheme handle?
Medical practice spreads into diverse specialisations. There is pediatrics; you need services for internal medicines, where we have all sorts of cases of diabetes, hypertension, heart failure, renal failure, and neurology.
We also have cases of different aspects of neurosurgery, cardiothoracic surgeries, general surgery, and all the rest of them. So, it depends on what category of medical treatment anybody needs. You can imagine that an elderly man will go into the hospital, have his cataract extracted, have his prostate removed, or if he has a hernia, because of age problem, igoscrical-hernia is done for him. From there we now go to oral care. So, in almost every aspect, the only area that we do not go into is infertility treatments, because we have limited funds, and we must have to guide the expenditure to take care of cases that may jeopardise the lives of all enrollees. Though, infertility is also a medical challenge that requires to be treated.
There have been cases where service providers complain that what BHIS pays them is not commensurate with their services. Consequently, drugs were not sufficiently given to the patients. Has BHIS resolved these issues?
Some of these complaints are blackmail; they are not complaints that should come to that level. For a healthcare provider to say he wants to be a partaker of the BHIS scheme, you must know how much is being paid, how much you are going to receive, and all that. If you have signed into it, it is against every norm for you to now go into the public to lay such complaints that what you are being paid is too small. But to directly answer your question, there are two basic ways we pay healthcare providers. In the insurance parlance, we call them provider reimbursement modalities. We reimburse them in two ways, one is called capitation, while the other is a fee for service. Capitation means that, for everyone that is enrolled in any hospital, whether or not, they avail themselves of medical services, the hospital gets paid on monthly basis. For us in BHIS, N400 is paid per person. Whether is the smallest baby or the oldest person? This sum cuts across the board, irrespective of age considerations. Whether they go to the hospitals for treatment or not, the service providers are being paid. When compared with BHIS, the NHIS pays N750 per head to all the hospitals within its scheme, so you can now ask why the BHIS is not paying the same.
There are so many misconceptions among enrollees concerning this scheme. What specific things would you say to allay the fears and doubts of the people?
A cousin of mine recently went to a hospital for a certain test, but when they refused to do it, he became very angry and phoned to inform me. Based on what he told me, I told him they are covering that test and so they don’t have the right to tell him they won’t. I spoke with the person on duty and was told the test he came for was secondary infertility, which is not covered by BHIS. The misconceptions are just a matter of understanding. BHIS went the extra mile to print issue fliers that contain the medical challenges covered by the scheme. Actually, what we handle spread far beyond the content of the fliers. Essentially, if an enrollee fails to read to understand what we do, there arise misunderstandings and subsequently, negative reactions. When an enrollee goes to his clinic on an emergency case, if it is beyond the capacity of the hospital to handle, it is under obligation to make all necessary arrangements for the patient to be referred to another hospital with the requisite personnel and equipment to handle the case. Therefore, it is improper to go to a higher hospital, before being referred to your primary hospital for medical attention. However, if an emergency arises, any patient is at liberty to rush into any BHIS hospital for prompt attention. This is because all BHIS hospitals are mandated to handle any such cases.
What are your last words to Bayelsans, especially the enrollees?
I will start with the government, because without their support, we may not have come this far. My last words for Bayelsans is that everybody should be appreciative of the government for setting up this scheme that has saved several lives than anyone can imagine. This is because, without the unflinching support of the government, we would not have been able to achieve much, in our individual capacities. It is not an easy task to set up a scheme, such as these, many issues had to be put into strict consideration. Undeniably, it is because of the nitty-gritty involved, that many states have not kicked off, even as they desire to get started. But not minding how herculean it is to set it up, having achieved this much, Bayelsa has become a shining example for others to emulate. We, therefore, need to be appreciative of the effort, by responding accordingly, by way of availing ourselves to the enormous potentials of the policy thrust. And so far, since we began, we have enrolled 119,000 people, as of May this year. This figure covers children, adults, civil servants, and private individuals. I still consider it necessary to appreciate Bayelsans that have enthusiastically keyed into the system; thereby making sure the scheme flourishes to its present state. The beauty of this scheme is that it is a social health insurance policy. This is because, as you contribute your quota, monthly into the coffer, you may not fall sick for months, but your contribution is somewhere saving lives. And when necessity takes you to your hospital, as what you may have contributed may not be enough to treat your case, others’ contributions come in to save your life. This is the beauty of the BHIS that has come to stay in our state. For emphasis, like the case of the triplets, I earlier told you, how could we have been able to finance the cost, if not for the contribution of the individual enrollees? It could have required nothing less than N4 million to handle the case. And for an enrollee that pays the paltry sum of N1,000 only on monthly basis, you can now imagine the ingenuity of the scheme; because the patient would have needed to pay for four years, which equals 48 months. So, how could we have achieved it? But as we gathered together, what others had contributed, we achieved success. You know that, in any society, it is poor that are more prone to sickness.
On the contrary, the rich have virtually all they need, proportionally, in terms of decent environment, balanced diet, and availability of medical experts at their call. But for the poor, it is not so. Essentially, while the high and mighty are contented with the much they can afford for the upkeep of members of their household, civil servants and other middle-class individuals make their monthly contributions which have over the years kept the scheme afloat. There are people that are contributing N600, N800 and they are the ones that enroll their spouses and four children. These are the people that contribute much, as some of them are level 15 to 17 officers. And some of the children presented are older than 18 years. So, these contributions take care of these other ones. BHIS has achieved more than I can enumerate at a sitting. There are countless testimonies to the effect, that this is one of the best things that have happened in Bayelsa State. We are considering bringing much of these testimonies to the notice of all Bayelsans via the mass media. Things are happening, as the list of beneficiaries keeps increasing by the day. Even as perfection is not achieved overnight, efforts are being intensified to ensure that everything is near perfect in our medical establishments, so as to record more success stories. There is a need for us to encourage our relatives, friends, and acquaintances that can pay, to enroll, so that we can help those that cannot pay, such as vulnerable people in our society. Some vulnerable people, in this regard, are the elderly, physically challenged, children, and all that are financially incapacitated. They need our collective milk of sympathy to be healthy. I will, at this time encourage us to keep the flag flying, as the management of BHIS is making all efforts to ensure that, successive administrations in the state build on the gains of this scheme. With all hands on deck, things can only get better.
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