Concerned stakeholders in the health sector on Thursday kicked against the appointment and imposition of a single insurance broker for the National Health Insurance Scheme (NHIS).
Lekan Ewenla, Publicity Secretary of Association of Health Managers (AHMs) raised the alarm in Abuja, at the second day of the investigative public hearing into the ‘compliance rate of the Health Management Organisations (HMOs), to the NHIS contributions and utilisation of funds by the health care providers and inhumane treatment of enrollees,’ held at the instance of House Committee on Healthcare Services.
Ewenla who accused the new management of NHIS of arm-twisting the Health Maintenance Organisations (HMOs), submitted series of documents to the commitee for further investigation.
“The current Executive Secretary of the NHIS went as far as appointing a single insurance broker for the HMOs as opposed to the list multiple brokers on their website from where HMOs choose brokers in the past based on preference.
“He also went further to negotiate insurance premium on behalf of HMOs higher than what obtained without our inputs,” he alleged.
However, other stakeholders who frowned at the level of impunity within the sector, called for removal of HMOs from the operation of health insurance scheme in Nigeria.
In his presentation, Ugwu Odoh, who represented Association of Health Care Services Providers, expressed concern over the fate of enrollees who have been caught in the cross fire between the HMOs and healthcare service providers.
“In prinicples, concept and design, the Federal Government of this country put together a formidable NHIS for Nigerians to rescue us from poverty, health degredation, but at the end of the day, what do we have, we have a beautiful concept on paper but in reality, the reverse has been the case.
“Any provider operating in less than any of these critical threshold is running at a loss. Over 95 percent of providers are simply subsidising the health care of ordinary nigerians. Because we are uncommon businessmen due to our training to save lives.
“Today it is said that N351billion has been spent in the last 12 years, but I can tell you that trillions have exchanged hands under the table.
“HMOs have been allowed to become too powerful in the scheme playing the roles of both middlemen and service providers,” he said.
Also speaking, Mustapha Jibril who spoke on behalf of State Commissioners of Health across the 36 states of the Federation stressed the need for government to make health insurance compulsory across all sectors in the country.
He noted that “currently, the role of the states is not being captured in the NHIS law and we are supposed to be in the scheme to domesticate NHIS by way of amendment to the current Act to capture the role of the state”.
While frowning at the excesses of the HMOs, he said: “After listening to the HMOs yesterday, I would want to say that they were not able to defend their position with regards to allegations of capitation and admin fees which I think is a very large amount and the HMOs could not defend their position there.
“We would like to see the HMOs given a different role to play in this, while they are also decentralised, since most of them are currently based in Lagos and Abuja with other state largely devoid of HMOs.
“It’s unfortunate to note that 12 years after, the scheme has been able to enrol just 1.5% of our total population. In countries where the health insurance scheme has been successful, the services of the HMOs have been eliminated. It has been practised in Ghana, Kenya, Rwanda and other places.
“Ghana set out on their health insurance journey 5 years ago, and record has it that they have achieved over 80 percent coverage for their population”, he said.
In a swift response to the allegations raised, Yusuf Usman, NHIS Executive Secretary described HMOs as “nothing but blood sucking monsters” who collect money from the NHIS and not render services.
He said in less than a decade, the NHIS has paid over N60 billion administrative fees, saying that if he deals directly with the service providers, he will enrol over 2.5 million Nigerians unto to the scheme.
Yusuf said he knows what he pays and the result he sees, coupled with the petitions he gets on daily basis from enrollees.
In his remarks, Muhammad Usman, Deputy Chairman, House Committee on Healthcare Services, recalled the position of the organised labour who harped on the need for NHIS to disburse funds directly to health care service providers as well as the need to conduct forensic audit of the HMOs.
“How can we cover the 180 million Nigerians using the NHIS? We are here for Nigerians and we want the NHIS to work,” Usman said.
On his part, Chike Okafor, Chairman, House Committee on Healthcare Services who presided over the session, said: “There are critical questions we’ve posed as part of what steered us in the face yesterday, which is that, how do we satisfy the needs of the enrollees.
“Must we have a third party payer (HMOs). Will there be any problem if the hospitals are paid directly?”
To this end, the Committee resolved to set up a sub-committee that will conduct forensic audit of the accounts of the HMOs and NHIS.
“The committee has heard all your submissions. A sub-committee will be set up to come over to your offices to look at your books,” Okafor said.
KEHINDE AKINTOLA, Abuja
