Dr. Ebun Sonaiya is a co-founding director of Total Health Trust, a Health Maintenance Organization HMO founded 1997. He was also the Founding President of the Guild of Medical Directors as well as being a member of other professional bodies. He has been nominated as a member to various committees at both State and Federal Government Ministry of Health levels on specific matters relating to health care delivery and health insurance. Dr. Ebun was a member of the National Committee on the Introduction of National Health Insurance in 1988. In an interview with him, he said that attending physicians have 100% professional liability for the patients. Excepts:
1.What is Total Health Trust HMO all about?
Total Health Trust Limited was founded in 1997 and commenced operations in the year June 1998. It is a leading health maintenance organization in the emerging managed care sector of the Federal Republic of Nigeria. With about 250,000 members or subscribers (or about 8% of the estimated population of the organized private sector with medical insurance coverage) at December, 2011, it is one of the largest HMOs in the Country. Total Health Trust Ltd is all about providing prepaid health insurance cover to individuals and corporate
2.How many plans does Total Health Trust have?
THT provides health care to individuals and corporate organizations. The Company, leveraging on its provider network, assumes control of the full spectrum of health care coverage to members during their subscription period. In keeping with its focus on customer service and promotion of member health, the Company has introduced a range of innovative cost-effective health plans and tariff structures. Below is the list of plans provided by us:
•Standard Plan – Outpatient services + Inpatient services only
•Silver Plus Plan – Outpatient + Inpatient + Dental Care
•Gold Plan – Full Outpatient & Enhanced Inpatient services
•Platinum Plan – Comprehensive
•traditional Managed Care
•Private Health Insurance (Fee-for-service) plan.
3.Is Total Health Trust involved in community health insurance or any other specialized /specific health insurance?
Total Health Trust is involved in plans for the informal sector such as artisans, taxi drivers and market women.
4.What makes THT different from other HMOs?
Total Health Trust (THT) is the first and only HMO with an international investor that brought not only money but technology, innovations and new plans with national and international appeal. Our core value is to deliver service with Respect, Compassion, Expertise and Pride.
5.What is the relationship with your healthcare providers like?
We are regarded as the most provider-friendly HMO in the country
6.Who regulates the activities of HMOs in Nigeria (Federal/State)?
National Health Insurance Scheme is the only regulator of health insurance in the country.
7.What is the difference between HMOs and Hospitals?
HMOs are funders, while hospitals/clinics provide healthcare services.
8.In case of physician’s negligence on the patient, who is to be held responsible?
Attending physicians have 100% professional liability for member/patients.
9.In case of medical emergency situation, does a patient need a referral from the PCP (primary care physician) in order to see another physician?
No, in an emergency situation no authorization is needed. However, a patient must be referred by any attending physician.
10.Do you agree with suggestions that health insurance is one way to check medical quackery in Nigeria and to what extent?
Health Insurance may not stop medical quackery all together but it can reduce it considerably
11.How will you rate the success of the scheme so far?
Disappointing in terms of coverage but fair in terms of operation and covered services.