HMCAN explains why public sector enrolees are ‘shabbily’ treated on health insurance scheme

The Health Maintenance Care Association of Nigeria,(HMCAN) the umbrella body of Health and Maintenance Organisations, (HMOs) has revealed reasons why Public sector enrolees are shabbily treated on the National Health Insurance Scheme in the country.

The health organisation body largely attributed the poor treatment of enrolees to the poor regulatory function of the National Health Insurance Scheme (NHIS) in addition to its persistent role as both a regulator and an operator ,which alters it’s focus.
”Ideally, the regulator was expected to regularly review the spread of the enrollees across the accredited primary healthcare facilities to ensure that the actuarial report/recommendation of 5,000 enrollees was achieved. NHIS also was expected to embark on systematic re-distribution of enrollees from the teaching hospitals to primary facilities with lower volume of enrollees.”Lekan Ewenla,the Publicity Secretary of HMCAN said in a statement obtained by BusinessDay on Tuesday.
HMCAN in the statement, raised further concern that warehousing of the fund for insurance sheme completely altered NHIS focus and understanding of their regulatory roles to that of operating the scheme and growing the funds to achieve a single pool fund scheme for the country.
Ewenla observed in the statement, that stakeholders in the health insurance scheme had earlier jointly agreed that the capitation,the fee-for-service,the admin fee,the price tarrif for the medications/consumables for primary healthcare services and all the denominated services at the secondary and tertiary levels should be upwardly reviewed by a determined percentage on an average of two years, to reflect the inflationary trend and ensure the provision of qualitative services at all times.
HMCAN, however pointed out that,”What is most disheartening, is the stagnation of the denominated services at the secondary and tertiary levels, since 2005 till date as the NHIS has completely jettisoned regulation and completely focused on marketing and growing the funds”
Citing further examples,HMCAN states that at the commencement of the programme in 2005,intermediate surgeries like caesarian section, were denominated at N55,000.00 appendixentomy was N35,000.00 and others,while adding that it does not reflect the current economic reality.
HMCAN calls further on the Presidency, the National Assembly and the judiciary, to set up a high powered investigative committee to dig deeper into the functions of the NHIS since inception, re-direct or re-emphasise their statutory function,and possibly consider the creation of a seperate entity that would anchor the disbursement of the funds as the only way to grow the scheme, and also achieve the Universal Health Coverage.
On steps to ensure growth of the health insurance scheme in the country,HMCAN wants the NHIS to render account of the deductible to the government and the general public.
“That the name of the National Health Insurance Scheme should be changed to National Health Insurance Commission, in order to make the agency strictly a regulator and not an operator and a regulator, as it is now.
It further states that that the Health Insurance Programme should be made ‘Mandatory’ for all Nigerians,while adding that that there should be a standard process of recruitment into the leadership position of the agency, considering the technicality of the industry.

 

HARRISON EDEH, Abuja