At a news conference in Abuja, the Health and Managed Care Association of Nigeria, on Tuesday, has said that it would write the National Assembly on the problems facing health insurance in the country.
The association which indicated that N351bn had been paid to health management organizations
The Chairman of HMCAN, Dr. Kolawole Owoka has said that worldwide, HMOs helped patients to get value for their money.
He stated that when anybody hears news that a big amount of money has been given to the HMOs; that money is not for the HMOs. That money is the total package of premium meant to provide services for all the stakeholders. Whatever the money is, 90 per cent of it goes for care. Care is paid for in two ways. “The first one is for primary providers and these primary providers are paid by what is called capitation, depending on the number of enrollees given to them. They are paid about 70 per cent. At the same time, if they (patients) are referred to the secondary or tertiary care, 20 per cent is paid for that.”
According to him, 10 per cent of the premium is administrative fees, adding that it was the function of the National Health Insurance Scheme, as the regulator, to ensure that all the processes were followed.
The chairman said the association would soon write the National Assembly to clarify issues relating to the health insurance scheme.
He stated, “All the publications in the papers are false and deceitful as far as this industry is concerned. There is no iota of truth in all the information. We are worried about this. This forum is majorly to clarify and debunk such information and plead with the National Assembly and other stakeholders.
“We are going to write them (the National Assembly) for an opportunity for us to state our own case page by page; paragraph by paragraph. They should also endeavour to extend another invitation to the NH IS for issues to be resolved.”
He called for a live coverage of the public hearing on the health insurance scheme for members of the public to be informed.
Also, the National Treasurer of HMCAN, Dr. Babatunde Ladele, said that at the inception of the insurance scheme, the HMOs, health care providers and the NHIS agreed that the government agency (the NHIS), should “warehouse the funds.”
He noted that the funds were for federal civil servants, adding that the agreement was reached to prevent rent-seeking.
Ladele stated that it is unfortunate to say that warehousing the funds with the NHIS is the bane of moving forward this programme. If the truth must be told, that is the bane because the regulator saddles itself with growing the funds and not growing enrollees.”
He added that before the HMOs received any money, they had to pay bond on such funds to insure and guarantee it.
Ladele stated that the association was very sad that what was happening in the health insurance scheme was being compared to the subsidy scam.
He said, “We are not interested in taking what does not belong to us. We are saying it with all sense of responsibility, if there a few people who are not playing by the rules, the Act is so clear on what the regulator needs to do to them.
“We have been trying to self-regulate ourselves, but we need the cooperation of the regulator. If we self-regulate, you cannot punish.”
He said the Executive Secretary of the NHIS, Prof Usman Yusuf, should be a friend of the association, adding that the group was ready to discuss with him.
On his part, the National Publicity Secretary of HMCAN, Mr. Lekan Ewenla also noted that since the appointment of the new Executive Secretary of the NHIS, there had been issues relating to the negative information being given to members of the public by the regulator.
Corroborating the chairman, he said the association would like to meet with the National Assembly “to put facts on the table.”
He stated. “The NHIS is supposed to be the regulator. There has been subtle competition between the NHIS and the HMOs.”
Also, the Secretary of the Health Care Providers Association of Nigeria, Nasarawa State branch, Dr. Godwin Obute, said that the health insurance scheme had been poorly advertised in Nigeria.
According to him, people in the rural areas do not know about the health insurance. “The NHIS has not invested in information dissemination about health insurance in the country. He also faulted a claim that enrollees were being short-changed by the HMOs and health care providers.