Dr. Babatunde S. Ladele, 60, the Executive Director (corporate Services), Clearline International Ltd. is a Consultant Family Physician and Anesthesiologist based in Lagos. He attended St. Paul’s Breadfruit Primary School, Lagos, Adeola Odutola College, Ijebu Ode, Ogun State and Basic Studies department, Kwara State college of Technology for his A Levels and had his medical trainings from the University of Lagos and Univesity of Benin. In an exclusive interview with Loveth Ezeugwu, Daniel Abraham and John Ameh, he talks on the issue of Healthcare Financing and operations of Health Maintenance Organisations (HMOs) in Nigeria.
1. What is Clearline HMO all about? Clearline International Limited is a National Health Maintenance Organization duly registered by the National Health Insurance Scheme (N.H.I.S) to underwrite health insurance as stipulated by the National Health Insurance law of 1999. With over two thousand (2000) affiliated healthcare providers nationwide, it is poised to offer medical services to employees and their families anywhere in Nigeria. Clearline International Limited is one of the pioneers in the industry. Our business is to source for clients, pool their premiums, register quality Care- providers and make sure that we have oversight functions on quality care. Clearline International Limited is there to assist the generality of Nigerian workers and interested healthcare utilizers in receiving the required qualitative and equitable medical attention from hospitals, clinics, and other health related professionals at an affordable cost.
2. How many plans does Clearline have? These are some of the health plans run by Clearline International Ltd.
Individual policy: For small groups such as Associations, Trade groups, old students associations etc. Clearline offers three policy types of the health plans which include bronze, silver and gold policies. Bronze policy holders are in shared wards. Silver policy holders are in semi-private wards and Gold policy holders are in private wards on admission.
Corporate policy: Designed for companies, industries, factories etc to help manage their health cost. Corporate health insurance plans are meant to support the health of your employees and ultimately your business; whether you are self employed, own a small business or multi-branched, multi-national company we will help you and your employees perform at peak. It’s also the ideal way to promote staff loyalty and can help you recruit and retain.
The corporate policy benefits include access to medical diagnosis and treatment in one of over 250 hospitals across the UK and also reduced sickness absence; providing medical insurance for key employees in an organization helps to reduce off-duty time due to ill-health.
Ultimate health plan: It covers unusual illnesses like cancers, complex surgeries such as kidney, heart, brain surgeries etc.
Diaspora health policy
The plan helps to remove the risk associated with sending physical cash home for treatment of loved ones. They get comprehensive gold plan for each relation at home. Payment is in foreign currency in the country of residence of sponsor whilst we do the location, identification and enlisting in appropriate providers anywhere in Nigeria.
3. In how many states are you operational? We operate in all the 36 states, including FCT, the state capital.
4. Is clearline involved in community health insurance or any other specialized /specific health insurance?
Yes. We are in Obio community in Rivers state in conjunction with Shell. Then we are involved in the MDGs (Millennium Development Goals), Health Intervention. We are in Oyo state, Ekiti state and the hot belt now (North East), Bornu state.
5. What makes Clearline different from other HMOs?
Our core vision is to be a leader in the industry; ensuring that every Nigerian has access to qualitative, equitable and affordable healthcare. It is a medical business,being run by a core medical group. Within the three of us, Managing Director, Dr. Segun Ogundimu; Executive Director (corporate Services), Dr. Babatunde S. Ladele and Executive Director (operations and medical service) Dr. Akin Akintunji; we have about 110 years of medical experience, that itself is considerable. We are very sensitive to Enrollees needs., We are totally committed, and focused on this cause. We try to make a difference, we don’t deny claims, we don’t put impediments., and we pay our Providers on time. Claims may be delayed a bit if it is not presented on time or if there is need for verification. We have a workforce of dynamic young men who are motivated and you see they are happy. At least you can see when you come around here and then we just got this new place and we are excited. People will like to do business with us because they know we are straight forward. They say you don’t sell a bad product twice. When we have an account and some other HMOs goes there to say we can do it for less price, we don’t quarrel, we withdraw but most time we write ‘Thanking you for letting us look after you’ we will be available in the future if you need us and they always come back. Some one year, some two years. So we must be doing something good for them to come back. Modesty apart, apart from being one of the pioneers, we are probably the best now in terms of being responsive to claims, doing what we are to do not using underhand tactics, denying Providers their claims or having what we call fine prints’ that become obvious when claims are to be made.
We‘ve lost some accounts just because we just want to be straight forward even when some of our friends come and say we can do this or that. We won’t bend backwards; our integrity cannot be compromised.
We are quick in reacting to claims, very important. We are very responsive to complains and I think that’s why we make our Care-givers do what they are supposed to do. As I told you, we are at the helm of affairs here. We are owners and so we are here. We are not the big men, we maintain a very open door policy and very approachable and that is what we have applied to our business as well. These are things we talk about that stand us among our peers.
6. What is the relationship with your healthcare providers like?
It would be better that you ask the healthcare providers. Give them a list of HMOs and let them know you are trying to pick ‘one’ and see whether they pick us or not.
7. Who regulates the activities of HMOs in Nigeria (Federal/State)?
That is the NHIS (National Health Insurance Scheme). I have expatiated on that and I told you that even before the NHIS, we were self regulating ourselves but we have the NHIS as the Regulator now. There is nothing like federal or state, it is strictly ’Federal’. They can’t be two regulators. Just like the central bank is the regulator for banks, there are states banks as well. The National Universities Commission (NUC) is the regulator for universities, there are states and federal universities but the regulator is still federal.
8. What is the difference between HMOs and Hospitals?
By definition of HMO- Health Maintenance Organization as I said, we look for providers, we register them, we look for clients, and we pool resources together. The clients have the choice of the hospitals they want. And it’s our own duty to make sure they get adequate and quality care. So the HMOs are not hospitals, they don’t give care directly; they give care indirectly through the various providers all over the country. We have close to 4,000 providers now all over the country. There is no nooks and crannies in Nigeria that we don’t occupy (operate in).
9. In case of physician’s negligence on the patient, who is to be held responsible?
There is what we call indemnity. That is like insurance. You need to insure yourself as a professional so that when there are malpractices, criminal or professional negligence, if you are found guilty, then your insurance is as stake. By and large, we are not going to be liable for what we didn’t do. But we are in position to prevent these things before and support the people who are hurt in the process. Then we don’t answer to other professional’s negligence. Once a physician is negligence, that physician bears the consequence.
10. In case of medical emergency situation, does a patient need a referral from the PCP (primary care physician) in order to see a physician?
In emergency situation, you can go anywhere but the enrollee should make sure his HMO is notified within 48 hours. And then most times, if there is such emergency that is let’s say the patient is unconscious, the card on the body gives idea of who he is and the ‘next of kin’ can be contacted and most hospitals know that immediately they are treating people that are not on our panel, they should let us know so they can make their claims.
11. Do you agree with suggestions that health insurance is one way to check medical quackery in Nigeria and to what extent?
I agree with you because once you pool resources together, catastrophic spending is ruled out. In other words, It is just like me now, if something happens and I need treatment for maybe a hundred thousand (N100, 000.00). I don’t have but once I have an insurance card, somebody takes care of that.
So if someone is already insured and he knows he can walk into any hospital, why will he want to patronise a quack? So once health insurance has found root, quackery will be a thing of the past.
12. How will you rate the success of the scheme so far?
Like all new things, the act didn’t make it compulsory and also the health seeking habits of Nigerians; when you talk of insurance, some people say ‘no, it’s not my lot’. So if you look at it from that part, you will say the percentage of people who have taken health insurance so far in Nigeria is so little and we can’t say it’s a success but the practice itself is successful. Successful in the terms that either told, it was never known, but now we know. It has been in doldrums since early 1960s but now it’s a reality and now it is gaining ground.
Once the initial act is repealed and we now have some level of compulsion just like car insurance, things will be better.
But in terms of success of the scheme, I would say yes; so far, so good.