• Friday, March 29, 2024
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NHIA Act: Govt, insurers agree on roles but employers undecided

NHIA Act: Govt, insurers agree on roles but employers undecided

The National Health Insurance Authority (NHIA) and health maintenance organisations (HMOs) have come to terms with the roles they will play in the implementation of the 2022 NHIA Act, after a spate of criticism against what was initially considered a gradual phase-out of private health insurers.

The introduction of the Act by President Muhammadu Buhari last year revoked the role of essential health providers from the functions of HMOs, reassigning them to offer only supplementary and complementary services based on users’ demand.

This generated heated debates on why key stakeholders were not engaged in the process and whether the authority had the legal standing to yank private companies off the core of a health insurance market that they have toiled to develop in the absence of the government’s capacity to provide widespread coverage to all Nigerians.

However, both parties are now on the same page as they have agreed to work on a set of guidelines that capture all concerns.

Emmanuel Ononokpono, NHIA spokesperson, in his response to BusinessDay’s enquiry, said “the operational guideline is being worked on” following a call for memoranda issued to the public to submit opinions, suggestions, and recommendations.

For the private sector, Leke Oshuniyi, chairman of the Health and Managed Care Association of Nigeria, a professional body of health insurance practitioners, said the NHIA director-general, has set up a committee to articulate guidelines for the industry as promised, adding that the committee was in the process of collating points of view across the industry.

A win-win document for all the stakeholders is expected to come up by the end of June, he said.

As of now, every Nigerian is mandated to subscribe to the national insurance plan, regardless of existing private plans.

“The services we will render will be complementary and supplementary, meaning those who are not satisfied with the government plan can buy a private plan as a top-up. But everyone must be on the social plan. It is how we will implement that we are working out,” Oshuniyi said.

According to the Act, public service workers at the federal level will contribute 1.25 percent of their basic salary while the government pays 3.75 percent, bringing the total sum to 5 percent of the employee’s basic salary.

For private employees, the employer pays 10 percent of the basic salary, the employee 5 percent, making a total of 15 percent. The sums are allocated to a risk pool and channelled towards the payment of care.

The NHIA Act suggests that employers have no choice but to sign up with government insurance, even if they choose to subscribe to a private HMO.

Pamela Ajayi, president of the Health Federation of Nigeria, said there are signs that the friction will be reduced to the barest minimum by the time the operationalisation of the guidelines kicks off.

“The policy is beautiful but the proof of the pudding is in the eating and we are waiting for full-scale implementation. The scheme allows for private health insurance and states that HMOs will carry out any tasks assigned to them by the state schemes. So HMOs will be a part of the system,” she said.

Companies hassle

The challenge brewing from this is that many companies are finding it tough to decide whether to dismiss their existing contracts with private insurers for the adoption of the national scheme or maintain both.

BusinessDay’s findings show that employers that place health insurance as a central feature of workers’ welfare are not set to part with what they describe as improved efficiency under private HMOs compared to government-run health services.

As a non-negotiable policy, they must subscribe. But despite running for decades, Abidemi Ajayi, group head of human resources at Coral Stone Capital, said the benefits of the national health insurance programme to employees could not be compared with HMOs.

Tunde Olagunju, human resource manager at Greensprings School, a British private school in Lagos, said: “Before the NHIA Act was gazetted, we had engaged a government agency, and I can tell the difference in terms of service between the private HMO and the government-backed one. There are differences in turnaround time, quality of service, and response time.”

Apart from the issue of poor efficiency feared under the national scheme, which has become mandatory, some organisations like Greensprings School said it will be too burdensome for them to bear the cost of subscribing to both schemes.

“Looking at it from a cost and goal view, it is not cost-effective. And in terms of the implications for the HMOs, the Act might subtly be killing some businesses. We are watching and waiting to see what the experience will be with employees, and as an institution, we are very particular about statutory compliance from government agencies,” Olagunju said.

Overall, analysts say it will boil down to the ability to afford private and government packages.

The federal government is likely to scale up its services, which a lot of people will opt for, given the affordability for nearly 90 million poor Nigerians. But those who want luxury care will go private.

“It’s like wanting to fly to the United Kingdom, some people will buy business class. Some will buy economy. Some will buy first class, which is five or six times the cost of the economy class. But everybody will get there. It is just that some people will have more comfort. With health, everybody will get well, but the amount of luxury and comfort may differ,” Oshuniyi said.