How to save NHIS, by HMOs
Why did the National Health Insurance Scheme (NHIS) run into troubled water?
It is because it transformed from being a regulator to a fund manager, Health Maintainance Organisations (HMOs), under the aegis of Health and Managed Care Association of Nigeria (HMCAN), have said.
HMCAN Chairman Dr Tunde Ladele and Publicity Secretary Lekan Ewenla spoke at a media roundtable in Lagos that the scheme’s problems had affected its performance and stalled enrolling. Ladele said: “The mismanagement started when NHIS was told to warehouse the health insurance fund. Since then, NHIS’ objective has changed from regulating the scheme to marketing and managing the fund. But this is not right according to the role of NHIS as stipulated by NHIS Act 35 of 1999.
‘’The Act says HMOs are drivers of the scheme. They are the risk bearers while the NHIS is the regulator. It is because of this that the NHIS has lost its focus and a lot of things went wrong. No regulator should market what it is meant to control.
“According to the rules, the capitation fee is meant to be prepaid, but now it is postpaid. This is another distortion. Money meant to be paid at the beginning of the month now comes as a postpayment which is why the quality of care given to enrollees is affected.
“We are suggesting that all premiums paid by enrollees should be warehoused with a National Health Fund possibly with the Central Bank to avoid undue interference and abuse by insurance administrators,” he said.
Another hole picked by Ladele in the scheme is the lack of equity in the distribution of enrollees from secondary and tertiary health care to the primary health care. ‘’The scheme as a social health scheme can only work if the volume of enrollees is much and it is the role of the NHIS to ensure that this is achieved,” he said.
He said the appointment of executive secretary of NHIS should not be political because it needs a technocrat to head same, “for the success of the scheme for all stakeholders. This is because health insurance requires a professional. Somebody who understands the nitty-gritty of healthcare delivery. A person that knows his onions when it comes to health financing.”
Another problem Ladele identified is the non-existence of a Governing Council, which made it easy for anyone occupying of the position of Executive Secretary (ES) to be a boss not answerable to anyone.
“We are faced with a situation that was not created by law in which an ES has becomes the sole authority to determine who is an HMO or care provider and even disburses more than what the law stipulates.
“The situation has become an aberration in which even the excesses of some HMOs could not be punished because there is no collaboration between the regulator and the HMO managers. We call on the public to forward to us any HMO that defaults and we will ensure discipline is enforced and the affected get redress. We recommend that the Federal Ministry of Health should constitute a Council for the NHIS to restore the confidence of enrollees in the beleaguered scheme.
HMCAN also supported the suspension of the ES and probe of the NHIS. ‘’It is time Nigerians knew how well their funds are managed by the regulators. Nigerians should not to lose hope in the scheme. It is the only means to get universal health coverage to every citizen. It is barbaric and archaic for the country to regress into the former situation where Nigerians were paying hospital providers mostly for services not rendered under the health retainership method,” it said.
It suggested a six-point agenda that could pull the scheme back on track, Ewenla said: “These proposals have been in the burner since 2005. It includes a short, medium and long term. It is long overdue that the National Assembly should consider upgrading the scheme to a full-fledged National Health Insurance Commission that will give room for better regulations, as well as make the scheme mandatory for all Nigerians to buy into and operate, rather than the voluntary exercise. It is only when every Nigerian regardless of status, creed or zone can be covered in the Universal Health Insurance that its maximum benefits can be felt by the large population of the country.
“If the law makes it compulsory for every employer whether in public or private to enrol their employees, and government also obeys the National Health Act of contributing the one per cent consolidated fund for those who are not covered by the formal or informal sectors, health insurance coverage would have gone a long way to reach several millions of Nigerians.
“There is need for retirees to benefit from the scheme, as well as more coverage of diseases, especially the non-communicable, which is increasing daily.
‘’The long-abandoned ICT platform should be activated. It will ensure proper documentation and enable the NHIS, as well as the HMOs, follow and monitor the fund activities by the HMO. It will guarantee transparency. All the running around for paper works and the feeling of embezzling will be taken care of. This is because all stakeholders and interested parties will be able to monitor via the internet how money is being pooled, disbursed and returned.”
“Technology has made it simple to regulate a system and monitor same by removing encumbrances, hence, it is only ideal to embrace online administration of the nation’s health insurance scheme as soon as possible,” Ewenla added.