How to improve health insurance coverage in Nigeria, by Ukiri
What went wrong with the NHIS especially as regards to reaching 90 per cent of Nigerians by 2015?
The NHIS was started with laudable goals and good intentions that were backed with political will. Since then, the law that set it up has not quite evolved to meet changing market conditions and a review is overdue. One could also say that the regulator, its role and operations, could have adapted better and faster to meet the demands of the healthcare needs of Nigerians.
We live in a very dynamic country and if we look at the Central Bank of Nigeria (CBN) for example, we can see how often they issue guidelines in reaction to changing economic winds. If viewed in this light, the NHIS can and should be more responsive to the evolving healthcare landscape; this will help achieve the wider and more effective healthcare coverage, we all hope to see in Nigeria.
What can be done to address these issues?
Firstly, the industry craves a regulator that is able to put the right framework in place, monitor operators (HMOs) and make sure our healthcare ecosystem actually works.There is also the need for improved capacity within the NHIS. As a regulator, it should have teeth to enforce the regulations. We have over 70 licensed HMO operators and there is much to monitor and implement. For example, our industry could do with a consolidation exercise that will result in Nigerians being served by more credible operators, with the financial strength and capacity to take the industry forward.
Another requirement is for legislation that makes it compulsory for every employer of labour, to ensure his or her workers subscribe to a health plan based on contributions from either the employer or employee. Currently, the current law is an Act that only states that a company with over ten employees may make provision for health insurance. We continue to push for legislation to make health insurance mandatory. Health insurance is just as important, if not more important, than pensions and other compulsory contributions. If the NHIS is supported by leadership from the Federal Government and a strong and effective regulator, the sky will be the limit.
Do you think that the frequent change of the leadership of NHIS is part of the problem?
The change in leadership has not been that frequent. Prior to the last three years, the NHIS was very stable with past Executive Secretaries having spent four to eight years at the helm. We do accept that the last three years have seen a frequent change in leadership but we should also remember that this period was politically tumultuous. We are sure that with the new Executive Secretary in place, stability will soon follow.
How far with the plan to use mobile phones to reach more Nigerians especially in the informal sector?
Any use of technology that enables health insurance products and services reach the mass public and is able to provide payment options that are flexible, modular and convenient is welcome and we take much interest. We maintain that their success or failure hinges on the full commitment of the all stakeholders, robust actuarial analysis that considers medical costs and anticipated risks and finally a wider education of the public to understand how health insurance works.
Another opportunity offered by mobile phones is the wide-scale accessibility it provides. Eighty percent of all online activity is done via a mobile phone, so it is imperative that, for those who seek information on subscribing to a health plan, the tools and resources are readily available. In recognition of this, Avon HMO use social media and our website to provide information on health insurance which goes to empowering people to live healthier, fuller lives. In addition, we are pleased that we are the first HMO to offer people the ability to buy a plan online via a computer, tablet or mobile phone.
The Guardian’s investigation revealed that the government is paying lip service to universal health coverage using NHIS because there is no provision for that in the 2016 budget. The N60 billion expected from one per cent of the consolidated national fund is not reflected. What is Avon doing as a critical player?
Let us look beyond the government and the budget. There is so much more we can do ourselves.There are many Nigerians who can afford to subscribe to a health insurance plan. As such, Avon HMO continues to work hard in encouraging Nigerians to prioritise their health and raise awareness of the benefits of private health plan subscription. We also continue to educate Nigerians on how easy it is to get access to good quality healthcare, by just putting aside a small part of their income.
What is the role of HMO’s such as Avon towards ensuring universal coverage?
Our role is to continue to educate the public on the benefits of subscribing to a health insurance plan. By bringing people together and pooling their money, members of the group can be cared for and everyone will have financial access to health care services when they need it.For many Nigerians with an income and can afford to put something aside for their health, we actively encourage them to subscribe to a health plan.
What have been the challenges of meeting your mandate?
A key challenge is the level of variability in quality and standards across hospitals. This variability can be traced to the absence of an accreditation system that independently assists and grades hospitals. If we had this, it would be easier to pay hospitals in accordance with their rating, especially if this body monitored quality standards in hospitals too. As a managed care organization, Avon HMO has a Quality Assurance department take new hospitals through an accreditation process.
Hospitals are accredited based on their quality standards and what we adjudge them capable of delivering. Following accreditation, we implement a quality assurance programme that requires regular follow-up and ensures that their standards do not fall. It is a huge task to undertake and bear but it is necessary. Fortunately, we have our tools and our resources to do this.
Another challenge is unhealthy competition. In a bid to grow the market, HMOs find themselves under pressure to underprice and undercut others. This inevitably affects their ability to pay hospitals on time and remunerate them adequately. In turn, service quality is affected and enrollees are not treated well. The impact of this is only felt at plan renewal where the dissatisfied enrollee (or company) will either terminate his plan or look for another HMO. But in looking for another HMO, they want to pay less, as they do not feel they received value for money in the previous year. This becomes a vicious cycle where everybody loses and further highlights the need for a regulator who would ensure fairness and healthy competition.
As a result of our commitment to not only contracting with hospitals on fair tariffs but also ensuring that hospital claims are paid on time and in full accordance with agreed tariffs, we inadvertently face another challenge. This means we are unable and do not engage in price wars with HMOs that may not share our commitment. So, as a result, we sometimes lose some prospective clients. However, we don’t tell stories – the testimonials of our enrolled members tell the stories for us.
What is your recommendation?
Much will depend on the regulatory environment. We are encouraged by the appointment of a substantive Executive Secretary for the NHIS. He has a huge task ahead of him, but we look forward to his reforms and will lend our support to them to ensure their success.