HMOs deny receiving N351bn from NHIS, want NASS to probe scheme

Health Management Organisations (HMOs) under the aegis of Health and Managed Care Association of Nigeria (HMCAN) has denied receiving N351 billion in the last 11 years from the National Health Insurance Scheme (NHIS).

Briefing journalists yesterday in Abuja, Chairman of HMCAN, Dr. Kolawole Owoka, noted that the said amount was paid as premium and warehoused in NHIS and not to the HMOs adding that 90 per cent of the money goes to health care facilities which includes primary providers which gets 70 per cent and the 20 for service fee stressing that only 10 percent of the fund is paid to HMOs.

He explained that before any money is given to HMOs, an advance fund is created which serves as a guarantee to ensure that the money is not lost.

Owoka said; “This is not in form of allocation of funds, it is a system that has been laid down in line with international best practices. The HMOs pay the health care providers for the services they provide to patients. The NHIS is there to ensure that the processes are followed. We are in the job of healthcare financing, we want to ensure that the flow of funds from the patients.”

Also speaking, the Public Relations Officer of the Association, Lekan Ewenla stressed the need to revisit the concept of health insurance in the country and appealed to the National Assembly to meet with the HMOs to enable them place facts on the table.

He observed that one of the key challenges facing the growth of NHIS in Nigeria is conflict and confusion adding that since inception of the scheme, there has been cat and mouse relationship as well as subtle competitions between the NHIS and HMOs.

Ewenla urged the NHIS to restrict itself to its regulatory functions and regulate the HMOs and Health care providers and allow the HMOs to drive the scheme as entrenched in the Act 35 of 1999.

According to him, NHIS should put in place the required enforcement and regulatory apparatus to enforce standards and ensure the growth of the industry.

Ewenla noted that the law establishing the scheme specified the roles stating that NHIS is meant to be the regulator while the HMOs are licensed to be financial managers and the intermediary between enrollees and health care providers to ensure that quality service is given at all times.

He alleged that a situation whereby the HMOs that have been empowered to drive the scheme meets NHIS officials trying to market the scheme to people and telling them to key into the scheme by coming to pay directly to them is creating a lot of conflict and confusion in the mind of the public.

“We possess the infrastructure and the financial muscles to grow the NHIS in the country. We should be allowed to grow the scheme,” he added.

The Treasurer and the in-coming Chairman of the council, Dr. Tunde Ladele, said that association will petition the National Assembly on the falsehood being peddled about the HMOs and stressed the need for the National Assembly to have an impartial view of the scheme and call for public hearing.

A member of the Healthcare Providers Association of Nigeria (HCPAN), Dr. Godwin Obute, said that the original intention of the NHIS was laudable adding that NHIS was envisaged as a scheme that relieve some burden on the common man.

Obute said, “Information about Health insurance in Nigeria is very poor, information about NHIS is very poor, the NHIS has not sensitized Nigerians enough on the need for health insurance. If the people in the village are not covered yet, it does not mean that that the scheme has failed. The National Assembly should come up with a legislation to make enrollment into NHIS compulsory and domicile NHIS in states, it will make coverage.”