HMCAN brainstorms on how to achieve UHC
Stakeholders led by the Health & Managed Care Association of Nigeria (HMCAN), the Association of Health Maintenance Organisations (HMOs) accredited by the National Health Insurance Scheme (NHIS), and accredited Health Care Providers (HCP) have developed a blueprint on how to achieve universal health coverage (UHC) using pre-paid mechanism of insurance.
The stakeholders in a communiqué released at the end of a forum for NHIS-accredited HCPs in the South South zone, Asaba, Delta State with the theme “Achieving Universal Health Coverage” recommended that HMOs and HCPs should work assiduously as a team to ensure the ultimate consumers of health insurance coverage, the enrollees, always have access to prompt and quality health care services with the overall aim of achieving UHC in Nigeria.
They recommended that HMCAN and HCPs self-regulate by ensuring compliance by HMOs so that capitation is paid before a new month begins and fee-for-service medical claims are settled promptly and health care providers provide quality health care services to enrollees without discrimination.
They said that HMCAN should assist HCPs by reaching out to NHIS to review upwards the current primary capitation rate of N750 per member per month due to the skyrocketing prices of medicines, consumables and medical equipment.
According to the communiqué, HMCAN should endeavor to make HMOs readily accessible to providers by ensuring that HMOs provide health care Providers with operational and functional contact addresses, phone numbers and email addresses.
The stakeholders said HCPs should regularly complete enrollee encounter data forms and submit to HMOs to facilitate submission of quality assurance reports to NHIS to help in data mining and health policy formulation.
They said that HMOs should make the benefits package for all private health plans for enrollees accessing care at each provider outlet available to the providers for smooth service delivery and prevent the delay that comes from insisting on calling for PA code even when the lines may not be going through.