Health Maintenance Organisations (HMOs) have raised concerns over what it called the disruption and distortion of payment of capitation and fee-for-services by National Health Insurance Scheme (NHIS) to HMOs.
The HMOs raise the concern that the distortion in the payments by the NHIS is already a breach to the quality of services to the enrolees by their respective healthcare providers.
“The scheme is supposed to be pre-paid and on a quarterly basis payment for the capitation, and fees for services by the NHIS. However, by the conduct of the Executive Secretary, he paid on 13th of January. On February 22nd, he paid the one for February, whereas the payment ought to be on quarterly basis to enable the HMOs disburse accordingly to healthcare providers to avoid frictions and inefficiency,” Victor Abasiakan Ekim, the legal adviser to the HMOs, told BusinessDay in Abuja.
Ekim also said, “It was the decision of the board that the payment for capitation is not disrupted and are paid quarterly, and are not post-paid to enable free flow of services. For him to change it to monthly payment is his own decision, which is contrary to the decision of the board.”
Furthermore, the legal adviser said, “There is appointment of broker, with an agreement for them to charge 1.5 percent as commission. Already, the various HMOs have their brokers, of which they had earlier negotiated their fees and some are paying 0.4 percent and 0.35 percent by some. Also, you appointed one and forced it on the HMOs, whereas the law makes provision for an acceptable insurance broker.”
He further called on the NHIS to follow accordingly the provisions of the Act establishing the National Health Insurance Scheme to enable it deliver effective services and achieve Universal Health Coverage.
Currently, only about 5 percent of Nigerians are covered by the National Health Insurance, leaving others to resort to out-of-pocket expenses for their health needs, which remains a source of worry.
Health analysts have insisted that the NHIS needs to work more closely with the HMOs to ensure a wider coverage of the Nigerian population, and further increase Universal Health Coverage, which is one of the focuses of the Federal Government.
