HEALTH MAINTENANCE ORGANISATION ARE NOT MERE CONTRACTION- SONAIYA.
In this interview a practitioner in the business of healthcare deliver under the aegis of the National Health Insurance Scheme (NHIS) debunks the feeling in some quarters that there are no clear indications that the scheme is right on the path of achieving government’s objective for establishing it, having been in operation for over a decade now. Dr EbunSonaiya, the chief Medical Director, Total Health Trust, a Lagos-based health maintenance organization (HMO), says the NHIS is a success “no matter who you ask” adding that HMOs are not mere contractors.
Q: could you enlighten us on the roles of HMOs in healthcare delivery in Nigeria?
A: health Maintenance Organizations HMOs are given the role of driving the national health insurance scheme in the country. Their functions include:
- Collection of premium from subscribers’ employer, groups and individuals.
- Accreditation and management of provider network
- Payment of capitation and fee-for-service.
- Oversight function and management of provision of quality medical benefits
- Quality assurance
Q: most service providers (hospital) see the HMOs as mere contraction out to maximize profit! Do you agree?
A: this is not truth HMOs, as stated above, are not mere contractors, but operate a system of financing and delivering quality healthcare.An ordinary contractor is pain to execute a given project and depending on how it is executed profit made could be anything from 40-60%. The profit margin for HMOs worldwide is no more than2-4% depending on management skills.
Q: as a HMO, does Total Health Trust see the NHIS as a success so far?
A: no matter who you ask, the newly introduced national health insurance scheme is a success. Although there have been challenges, but then these are not insurmountable.
Q: public awareness on the relevance of the NHIS to general public healthcare delivery in Nigeria is negative. Suggest practical steps to reverse this notion.
A: one is not aware that public perception of the NHIS is generally negative. That is not to say there have not been issues about the quality of care timely payment of capitation and fee-for-service etc. But these are teething problems that will reduce with maturing maturing of the scheme.
Q: A section of the working population itself hails the NHIS even when the grumble that not much is being derived from the HMOs and service providers from the HMOs and service providers. Can we have your comments?
A: as already stated, there will be and there are indeed initial challenges most of which will be resolved. Do not forget the scheme is barely two years old.
Q: what is the future of NHIS as a genuine vehicle for total care delivery in Nigeria as it seem to have remain segregation AL so far?
A: the future of the scheme is bright giving every one commitment to its success. however, one does not agree that it is segregated in anyway. It is been introduce to faces. The federal civil savant and government parastatals, then the state civil savant and general public. It must not be forgotten that the private sector as embraced pre-paid health insurance long before the public sector.
Q: some HMOs are entrepreneurs who are non-specialist in medicine and healthcare services. Is it proper?
A: while it could be desirable to have many healthcare professional be part of ownership of HOMs it is not compulsory. HMO business, like other businesses, must meet personal requirement before being registered. If the principle is adhered to them ownership will not be an issue as it will be run by people with appropriate professional qualification and requisite experience.
Q: is it true that the NHIS as produce more complaints then real service?
A: absolutely untrue!
Q: who is Dr. sonaiya
A: An ordinary Nigerian doctor who has devoted and still devotes all his time to adequate funding and provision of quality healthcare to all Nigerians in an equitable manner.