Aside non-accessibility of healthcare services, another obstacle many Nigerians complain of is non-affordability. In this interview with OYEYEMI GBENGA-MUSTAPHA, the Director, Managed Healthcare Services Limited (MHS), Dr Gabriel Idahosa, speaks on how Health Maintanance Organisations (HMOs) are bridging the gap.
As the director of an organisation that is among those that were the earliest Health Maintanance Organisations (HMOs) registered by the National Health Insurance Scheme (NHIS), how will you assess the sector?
The health care maintenance industry did not exist about 15 years ago and health care maintenance organisations do what is simply ‘pooling of resources’, because anytime an individual goes to the hospital he/she has to pay the bills if he does not have any other person to pay it. So, what health maintenance does is to bring a lot of people together who pay a fixed amount monthly or yearly with guarantee that if at anytime they need health care, they can walk to their healthcare provider and get services and whatever the bill is, it is the health maintenance organisation that pays. So, once you are subscribed to a plan of Managed Healthcare Services Limited (MHS), for instance, and you have paid your monthly or yearly subscription fee and you then need to see your doctor, you will get treated. All you need do is to present your NHIS card and thereafter get the treatment and go away. The doctor or hospital sends the bill to MHS to settle. It guarantees you access to healthcare and you don’t have to have the anxiety of having to pay each time you go because you already have a plan that covers you and your family. If your wife or child needs medical care and it is under your plan, you don’t have to worry about not being around the family, all they just need is to go to the hospital and get treated. It is something that has been done in other countries for a long time.
About 15 years ago, Nigeria didn’t have it, MHS and a few other organisations were the pioneers who worked with the government, convinced the government to set up a regulatory body called National Health Insurance Scheme (NHIS), which regulates the industry and gives licences for operators.
There is the issue of ease of use of healthcare facilities by subscribers. What is your take on this?
MHS was one of the first HMO to get a licence and since then, has been one of the leading HMOs and it has, among its list, very large Federal Government and private agencies. We have offices and staff in all the states of the federation and the Federal Capital Territory (FCT). So, whenever our client is out of his state of residence, he only needs to identify our service provider in any of the states to access healthcare services. So, even if a member is travelling outside the country, he only needs to identify a provider by MHS in the neighbourhood and go there and show his or her card or NHIS number, the hospital will contact MHS to confirm if he or she is registered with it. So, even if your provider is in Lagos, you can get another provider in any part of the country to attend to you once you show your card or number and they are one of our listed provider. It guarantees you freedom of access where ever you are. It is not a case of I am resident in Lagos and it is only in Lagos I can get access to healthcare. If you have a health issue outside Lagos, you don’t have to take care of it by yourself. MHS gives you access and freedom of choice of location. Another initiative MHS is doing as part of the accessibility and affordability reform to get results is that it helps the companies to have a fix on what they will spend in a year. So, if a company has 100 workers and agrees on an amount with MHS, that company will know it cannot get bills from different hospitals its members of staff go to when they access treatment. The bills do not go to the hospitals either, the bills go to MHS. MHS has foreknowledge of the company’s budget for the year and it is not shocked, but rather deep into the ‘pool’ and settles the hospitals based on how much the company will spend on staff treatment. And for the staff, it gives peace of mind that the employers have paid for his or her treatment with MHS and they can go to any clinic to get treated anytime.This is a service that has been perfected and has become reliable for a large number of federal agencies and private agencies.
Is it the same plan/policy for your clients who choose this?
No. There are several types of plans. We have the basic plan, which is for people who just want to go to the hospital. There are other levels of plans where you can go for admission; and very high level where you can be entitled to evacuation to any foreign country for treatment depending on your level and what type of plan you can afford, that covers a whole range of services you enjoy as a subscriber to an MHS plan. There are various levels or plans these are – Basic, Silver, Platinum and so on. For some plans, you are entitled to all the treatments things. When you pay for a plan that includes over-seas evacuation; for example, when you enrol for the plan, it will be clearly stated in what you get, that you are entitled to all these things so it is up to the individual registering to make that kind of choice.
How has the public embraced this initiative?
The evidence of that is that we have a very large number of people that are from members of the public that are not federal agencies and there are a very large number of companies that have enrolled with MHS. In addition, because of the benefits we offer through this initiative, individuals register themselves and their family, groups like cooperative societies, and communities subscribe to the health plan as well. It has an extra benefit of operating within one’s budget that is why a lot of associations are subscribing their members. And it is funny that based on this, many people are joining such associations to benefit from this plan.
Since the introduction of HMOs, how can you assess the state of wellness of Nigerians?
Wellness in terms of physical wellness or fitness, HMOs have not done much. HMOs really are to champion preventive healthcare, so that not much money will be spent on treatment. There is the need for HMOs to create this awareness. Awareness for people to be better informed about what you need to do to be healthy. The HMOs have to do more of health education, which is the major activity of the HMOs. They should organise health sessions with the companies who are their customers and organise for communities who are not even their customers as part of their CSRs (corporate Social Responsibilities).They should go to communities or associations to deliver health care education because a lot of illnesses occur because of ignorance based on the food you eat, lifestyles. If you have knowledge of those things, you will be safe. HMOs know what to eat, the kind of exercises people need to do, type of lifestyle to lead, how you sit down, the type and correct posture when you sit i.e when you have back or neck pain. The basic information on health must be given. In fairness to MHS, it does these all the time for its customers or be invited by groups who are not customers to come and give health education to staff.
Are you saying HMOs are principally after profits and are under serving Nigerians?
An HMO is a health maintenance organisation not a disease curing organisation. In maintenance, you already have good health but HMO wants to ensure that you continue to maintain that good health. The last thing an HMO wants to do is to go to a hospital, it will prefer that your health is good. For instance, when some take insurance for a car, it is not that they want to have an accident with the car but you really don’t want to have an accident with the car. It is the same thing. An HMO really doesn’t want to go to the hospital. So, at MHS, we try to give you the education that you need to have your good health so you don’t have to go to the hospital, but if after all of that you still have to go to the hospital, then we are ready to make sure that you don’t have an unhealthy body.
In Nigeria, there is problem of compliance to an agreement. In 15 years, what has been the compliance level for individuals, associations and groups towards their subscriptions?
Like every other business, there is a level of performance; it will take about 100 activities to determine some things. Whether it is paying bills or people going to work, you find out that people will be late, it happens also in the industry. Some subscribers may delay in payment, some may come and negotiate with you and say this is when they want to pay, some even pay in advance before you ask them to pay. I will say in the industry the compliance level is very high. We have about 90 per cent enrolees who pay on time. We still have that small percentage of people who delay payments and are owing but the compliance level is very high, because it is about your health not about something else like house rent, or a car.
President Muhammadu Buhari has presented a budget to the National Assembly. As an expert, which areas do you advise the Federal Government to look into so that the major health challenges can be tackled?
HMO as an organisation believes that preventive medicine reduces the number of people who attend the hospital. So that should take a lot of our budget allocation. This is because if people are not sick, the government will not need to maintain the hospital with a lot of money, in form of facilities. A chunk of previous budget goes to public health facilities and institutions in form of salaries and commodities. So, the minister should ensure that he reduced the rate at which people go to the hospital. A healthy community will give a clear view of what our budget is meant to address. Everything about health is about the well-being of the people. There are three things we need to do when we talk of medicine – access, adequate human resources, infrastructure and affordability.
Acessibility can be seen from three perspectives – the presence of a facility (physical structure) called a health care facility does not automatically mean a person has access to the health care facility. The healthcare industry means health care facilities from the primary, secondary and down to the tertiary/teaching hospitals that are functional and should have the necessary equipment and environment to ensure that they work. They must have the equipment in place, the manpower, and the environment to make them work effectively. You must put in place a budget to ensure that once you walk into an hospital, you get that treatment that is comparable with what we get in any other part of the world.
The issue of health care tourism is a problem. We have many Nigerians getting treatment abroad, not because they can’t get the treatment here but because they have the feeling that the facilities are not there.
The right healthcare personnel and availability of drugs are also important. If these things are addressed in such a way that people will have faith in our structures, that they will get the right treatment and the right personnel, then no one will go far.
But it is not everybody that is expected to walk into a secondary or tertiary facility…
The primary health care level is where most Nigerians access care. The primary health care centres must be made to function. We know that it is the government that is meant to take care of the primary health care facilities but I will believe that the local government should take it from where the Federal Government reached. It should ensure that the primary healthcare facilities are well taken care of, while the Federal Government and even some states take care of the tertiary institutions and secondary health care facilities. Nigerians should get to a stage where they will feel comfortable that they will get that anticipated level of care.
Some things that are necessary are adequate water resources and infrastructure. We must work within the context of infrastructure and institute an efficient healthcare management system that will enable us measure the industry. For instance, on a particular day, the number of deliveries that took place, or say, we had a number of people coming to access healthcare facility, determining the particular causes of illnesses and the number of people with that illness. That will help us plan and when planning, we can say, since we have so many people coming up with malaria, can we have an effective intervention to prevent malaria or since we are having these number of deliveries? Can we plan and say what the population of Nigeria is going to be using these basic important healthcare indices and statistics. Getting these proper healthcare statistics is important in planning and the development of any nation.
Many enrolees complain of not getting their cards. How are you resolving this at the MHS?
The essence of the card is for the provider to see that the person is an enrolee of MHS. Each card has a number. If you don’t have the card but has a number and you tell the hospital or the MHS,you will be attended to. Most people will copy that number and leave the card at home than leave the card at home without copying the number. Two things we look for in the card are the number and photograph but if you have the number and they access their system and identify you with that number, they will give you the treatment. Most people normally will carry their cards.
