The Nation Newspaper

Tag: HMOs

  • HMOs urge government to address illegal health insurance practices

    HMOs urge government to address illegal health insurance practices

    The operators of Health Management Organisations have called on the Federal Government to address the issue of illegal health insurance practices in Nigeria.

    The HMOs under the umbrella body of Managed Care Association of Nigeria queried government agencies floating of HMOs, which contravene the law setting up the National Health Insurance Authority.

    The police and the Nigerian National Petroleum Corporation run separate HMOs.

    The Permanent Secretary, Ministry of Defence, Dr. Ibrahim Abubakar Kana also recently dropped the hint of setting up an HMO for core civil servants.

    Kana had blamed some flaws in the existing HMOs for the idea of having a separate one for core civil servants.

    But the Health and Managed Care Association of Nigeria said the idea was illegal and contradicts essence of government, which is to provide enabling environment for private sector to thrive.

    Dr. Lekan Ewenla, the spokesperson of the group, said it was only the military that was allowed to float a separate HMO because it has its own hospitals and health personnel across the country.

    Ewenla stressed that every other separate HMO should be deemed to be illegal.

    He, therefore, said the permanent secretary’s latest call, though knocked back by the Minister of Health, Muhammad Pate, should be investigated.

    He also said the government should further investigate the same abnormalities perpetrated by those behind the setting up of the Police HMO and NNPC HMO.

    Read Also: National Assembly halts amendment of CBN Act

    Dr. Ewenla said the law was self-explanatory as it places the private sector as the driver of the scheme.

    He stressed that it is no longer government business to do business.

    Ewenla said what is expected of the government is to provide the enabling environment for the private sector to drive the economy, while providing the regulatory framework.

    He said, “From the law setting up health insurance in this country, and the guidelines guiding the operations of insurance in Nigeria, it’s very clear that health insurance is a private business that is meant to be driven by private individuals, private companies that are  registered by CAC and have fulfilled all the requirements of the law.

    “For example, in this country, we have three categories of HMOs. They have City HMOs, Zonal HMOs and National HMOs. The requirement for share capital for national HMO as we speak today is N750 million.

  • NHIS delist 23 HMOs, grant 34 provisional nod 

    ..target 10% fresh enrolle annually

     
    The National Health Insurance Scheme Thursday announced that 23 Health Management Organisations, (HMOs) have been axed for failing to meet up with the minimum operational criteria expected of them.

    This is as the scheme set a modest 10% fresh enrollment target annually.

    The decision was reached after a validity test carried out on all the 57 HMOS operating in the sector.

    All HMOs operating in the scheme are expected to renew their accreditation every two years, while some of them had their accreditation last since 2013.

    According to the Chairperson of the Board of NHIS, Mrs. Enyantu Ifenne, only one out of the 57 HMOs actually scored 100% and is therefore granted accreditation to operate.

    Ifenne who briefed the media alongside other members of the board,  noted however that 34 others were granted provisional accreditation until they are able to fulfill all the conditions spelt out for the reaccreditation process, while 23 were denied reaccreditation as they failed to meet the minimum standard.

    Explaining the criterial for scoring the HMOs, She said, “they scored the HMOs based on aggregation of criteria and at the first cut, only 11 out of the 57 HMOs scored over 70 per cent, 40 HMOs scored between 50 and 70 per cent while 6 HMOs scored below 50 per cent.

    “The committee re-examined this and reduce the score further from 70 to 50 percent but only the Defense HMO fulfilled met most of the condition. But if we apply the law, none of the 57 HMOs fully met all the NHIS requirements for accreditation. We have advised that the 11 HMOs that were recommended for provisional re-accreditation should comply with specific critical condition within two to three weeks before they can be fully accredited.”

    She further explained that the 46 HMOs who score below 70 per cent were disaggregated depending on the critical condition they did not fulfill adding that the six HMOs which score less that 50 percent were removed from evaluation. “That means they are not being considered for re-accreditation.”

    Dr. Ifenne said another score they used as a critical irreducible minimum was the adequacy of payoff shares capital. “The payoff share capital for National HMOs is N400 million, zonal coverage is N200 million and the state coverage is N100 million. And this is a critical requirement because the Payoff capital share of a company is a requirement for accreditation and evidence of their financial stability.”

    She also said HMOs were also required to submit their audited financial report from 2014 to 2016 but with criteria, six did not meet the requirements and one did not submit audited financial report and corporate affairs commission document, therefore removed from further consideration.

    She added that the purpose of the conference was to bring to the notice of Nigerians that decree 35 of the scheme gives the council the power to re-accredit HMOs and lay out clearly the condition and processes through the operations and guideline that were drawn down by the Act.

    She also gave some criteria considered for accreditation as; registration with cooperate affairs commission, adequacy of payoff share capital, current asset including fix asset, shareholders composition, company reserve, integrity of shareholders, composition of Board of Directors, current tax clearance of companies, current tax clearance of all Directors, appointment of audit fund and submission of audit account to NHIS as and when due, compliance with Pension PENCOM Act among others.

    The new NHIS board Chairperson who also bemoaned the low number of people participating in the scheme said the board has set a moderate target of 10% increase annually in the bid to ensure universal coverage.

    She said, “It is humiliating the fact that health facilities are reluctant to accept NHIS lives (Enrollee) is an indictment on NHIS as public entity because what we see with this reaccreditation is accumulation of regulatory failure. Accreditation should not be the only time we know that the company is bankrupt or nonexistence or sold to South African entity. If we were up and doing and on our toes in applying the regulatory powers giving us under the law, this should not happen. And this board is committed; this will not be allowed to happen. We have directed management to submit to us at the next board meeting the protocol and plan of regulation of HMOs. We will approve and put in place immediately this includes monthly returns, examine their accounts because we have the power to examine their accounts. So we will know when they are defaulting. We are committed to flipping the organogram. The value chain, currently, the NHIS at the top, the HMOs, the healthcare providers are the next rung and the enrolle are at the bottom and are caught t in the veil of the power tussle. Elephants have being fighting, grass is hurt. Grass is the people we call enrollee. I hate that word. Enrollee just reminds me as if they were conscripted. They have no choice, no actions that they have to take poor service whether they like it or not or opt out.”

    She also noted that the board was prepared to change the current trend that places the enrollee at the bottom of the ladder. She said enrollee would be moved to the top of the ladder; stressing that the satisfaction of the enrollee would be the watch word in the new dispensation.

    She also charged the HMOs to do their business transparently and accountability while making profit.”

    She also assured them that the reaccreditation exercise was not meant to cripple any HMOs.

    “With this shift, the healthcare providers will be held to account not only for the quality care but also for the humanity because from the information we have most in the scheme are treated as second rate patients. So we all NHIS, HMOs and healthcare providers have to work so that the enrolle is at the tip of the value chain and the enrollee becomes the first in the universal coverage.

    “We are going to redefine the processes and focus NHIS to stand up to its regulatory function. The failure to meet our regulatory function is the reason why this plague has being spread, not validated and no punitive action taking. We want to change that, we must change that. The HMOs as you can see are doing their best but they have not been regulated appropriately, we must apply the tools. They are willingly to subject themselves to regulations if we stand up to our duties. I don’t think any of them, except may be a few rascals want to ruin this game. Similarly, the healthcare facilities beam torchlight all the time. I believe that many of them would rather deliver quality service, they are in position to do just that.”

    In his remark, the Executive Secretary of the scheme, Prof. Usman Yusuf pledged that he will ensure that NHIS does the right thing moving forward and serve the people better.

    “For a very long time, we have not being doing the right thing. I pledge as the Chief Executive of this agency, that I will do all I can to put the enrollee at the Centre rather than in the last position.”

    He also denied the allegation of investing the fund of the scheme in business without due authorization, saying no Penney of the fund was invested anywhere in the country or outside the country.

    Besides, he said the scheme has the right to invest its fund according to the law but it has not done that as the board has put a hold to the idea.

    This was also colloborated by the chairperson of the board.

    NHIS board also vowed to recover any money of the scheme that may be with the government, stressing that the money does not belong to government but the people.

    Read Also: ‘Only two per cent of Nigerians have enrolled for NHIS’

  • How to save NHIS, by HMOs

    How to save NHIS, by HMOs

    Why did the National Health Insurance Scheme (NHIS) run into troubled water?

    It is because it transformed from being a regulator to a fund manager, Health Maintainance Organisations (HMOs), under the aegis of Health and Managed Care Association of Nigeria (HMCAN), have said.

    HMCAN Chairman Dr Tunde Ladele and Publicity Secretary Lekan Ewenla spoke at a media roundtable in Lagos that the scheme’s problems had affected its performance and stalled enrolling. Ladele said: “The  mismanagement started when NHIS was told to warehouse the health insurance fund. Since then, NHIS’ objective has changed from regulating the scheme to marketing and managing the fund. But this is not right according to the role of NHIS as stipulated by NHIS Act 35 of 1999.

    ‘’The Act says HMOs are drivers of the scheme. They are the risk bearers while the NHIS is the regulator. It is because of this that the NHIS has lost its focus and a lot of things went wrong. No regulator should market what it is meant to control.

    “According to the rules, the capitation fee is meant to be prepaid, but now it is postpaid. This is another distortion. Money meant to be paid at the beginning of the month now comes as a postpayment which is why the quality of care given to enrollees is affected.

    “We are suggesting that all premiums paid by enrollees should be warehoused with a National Health Fund possibly with the Central Bank to avoid undue interference and abuse by insurance administrators,” he said.

    Another hole picked by Ladele in the scheme is the lack of equity in the distribution of enrollees from secondary and tertiary health care to the primary health care. ‘’The scheme as a social health scheme can only work if the volume of enrollees is much and it is the role of the NHIS to ensure that this is achieved,” he said.

    He said the appointment of executive secretary of NHIS should not be  political because it needs a technocrat to head same, “for the success of the scheme for all stakeholders. This is because health insurance requires a professional. Somebody who understands the nitty-gritty of healthcare delivery. A person that knows his onions when it comes to health financing.”

    Another problem Ladele identified is the non-existence of a Governing Council, which made it easy for anyone occupying of the position of Executive Secretary (ES) to be a boss not answerable to anyone.

    “We are faced with a situation that was not created by law in which an ES has becomes the sole authority to determine who is an HMO or care provider and even disburses more than what the law stipulates.

    “The situation has become an aberration in which even the excesses of some HMOs could not be punished because there is no collaboration between the regulator and the HMO managers. We call on the public to  forward to us  any HMO that defaults and we will ensure discipline is enforced and the affected get redress. We recommend that the Federal Ministry of Health should constitute a Council for the NHIS to restore the confidence of enrollees in the beleaguered scheme.

    HMCAN also supported the suspension of the ES and probe of the NHIS. ‘’It is time Nigerians knew how well their funds are managed by the regulators. Nigerians should not to lose hope in the scheme. It is the only means to get universal health coverage to every citizen. It is barbaric and archaic for the country to regress into the former situation where Nigerians were paying hospital providers mostly for services not rendered under the health retainership method,” it said.

    It suggested a six-point agenda that could pull the scheme back on track, Ewenla said: “These proposals have been in the burner since 2005. It includes a short, medium and long term. It is long overdue that the National Assembly should consider upgrading the scheme to a full-fledged National Health Insurance Commission that will give room for better regulations, as well as make the scheme mandatory for all Nigerians to buy into and operate, rather than the voluntary exercise. It is only when every Nigerian regardless of status, creed or zone can be covered in the Universal Health Insurance that its maximum benefits can be felt by the large population of the country.

    “If the law makes it compulsory for every employer whether in public or private to enrol their employees, and government also obeys the National Health Act of contributing the one per cent consolidated fund for those who are not covered by the formal or informal sectors, health insurance coverage would have gone a long way to reach several millions of Nigerians.

    “There is need for retirees to benefit from the scheme, as well as more coverage of diseases, especially the non-communicable, which is increasing daily.

    ‘’The long-abandoned ICT platform should be activated. It will ensure proper documentation and enable the NHIS, as well as the HMOs, follow and monitor the fund activities by the HMO. It will guarantee transparency. All the running around for paper works and the feeling of embezzling will be taken care of. This is because all stakeholders and interested parties will be able to monitor via the internet how money is being pooled, disbursed and returned.”

    “Technology has made it simple to regulate a system and monitor same by removing encumbrances, hence, it is only ideal to embrace online administration of the nation’s health insurance scheme as soon as possible,” Ewenla added.

  • ‘Innovate to deepen health insurance’

    FOCUS on innovation, especially product development, would deepen health insurance penetration in the country, Managing Director Avon Healthcare Limited, Mrs. Adesimbo Ukiri, has said.

    She spoke in Lagos. According to her, innovation should play a leading role in the evolution of health insurance and the drive to achieve universal health coverage in Nigeria.

    She noted that with a population of about 170 million, the ability to innovate and come up with different products to meet the needs and requirements of the diverse market segments that exist in the country is crucial.

    She also called for innovation in channel development, which in her view is a requirement for offering health insurance products to previously un-served market segments.

    This, she said, would open up new opportunities for the industry.

    Ukiri, who observed that the informal sector, had been ignored by health insurance companies with the focus of most HMOs on a maturing and over served corporate market segment, said there was need for concerted efforts among HMOs in the industry.

    She said: “We need to move away from this trend if we are to progress beyond the current four per cent health insurance market penetration. We find that there is room for innovation in the use of marketing channels and the way HMO products are being offered to the market. There are limited number of people who can be reached when industry players rely heavily on their sales staff.

    “This has meant there is a large proportion of informal sector segment who would like to buy into health insurance services but have been unable to do so.”

    For her firm, she said the company would continue to play a key role in innovations that will ensure healthcare was accessible to all.

    “At Avon HMO, we are talking to our peers about the need to collaborate in order to innovate. The market is one of great scale and the industry must work together to create the structures needed to achieve rapid market penetration.

    “This will lead to extended reach, expanded market size, more efficiently priced cost of care, wider benefit coverage on plans and ultimately, lower premiums per head,” she added.

  • HMOs, microfinance banks partner on healthcare financing

    IN its quest to provide effective and affordable healthcare services to the poor, health management organisations have worked out modalities with selected microfinance institutions operating in the country aimed at developing products and services that are pro-poor.

    This was part of the resolutions reached at a public forum tagged: ‘Market Place Event for HMOs/Microfinance institutions’ facilitated by DFID-Partnership for Transforming Health System (II), Lagos, recently.

    The project, which is a pilot scheme, is expected to take off in Lagos soon.

    Justifying the need for the project, Dr. Ayodeji Ajiboye, Health Financing Officer, PATHS2 Lagos, said, “It is important that the poor are covered by a form of financial risk mechanism because they are exposed to a lot of health expenditure and a lot of time they have to run helter-skelter borrowing to finance health needs and sometimes this leads to bad consequences like death or permanent disability. By having a health insurance, the client would have prepared for the services and get prompt treatment. PATHS2 sees this as a way of mobilizing private resources, by way of the HMOs and MFBs together to provide health insurance to the clients of the MFBs.”

    Expatiating, Ajiboye said the initiative is “PATHS2’s way of contributing to service delivery by way of making affordable health insurance product available to the poor. It is a pilot scheme and a unique model leveraging on the expertise of the HMOs to provide health insurance products and then the huge client network of the MFBs as well in addition that they already have mechanisms in place to collect regular money from their clients, which the premium could actually be spread to health as well.”

    At separate presentations, Dr. Deola Majiyabge, Executive Director, Total Health Trust Ltd, Mr. Ayobami Ogungbemi, Head, Business Development, Healthcare International Ltd, Dr. Victor Benebo, Executive Director, Mediplan Health Management Organisation, noted that there was need to design a pro-poor health scheme for the under-privileged which would help reduce the burden of astronomic health expenditure.

    In an interview with Mrs. Itohan Osayi, Assistant Manager, LAPO, a microfinance institution, she lauded the innovative project, saying it has the potential to deliver pro-poor healthcare services to the targeted audience.

    “The MFBs have products that are tailored to service the low end population so partnering with the HMOS is an effective way of delivering the good for the better majority”, Mrs. Osayi noted.

    Echoing similar sentiments, Mr. Tope Oloniniyi, Director, Infinity Microfinance Bank, said the scheme holds a lot of promise for achieving financial inclusion.

    “If well-managed, this healthcare financing scheme by PATHS2 could also help to grow substantially the percentage of the unbanked populace currently put at 67 % by the Central Bank of Nigeria (CBN)”, Oloniniyi stressed.