The current face off between the Health Maintenance Organisations (HMOs) and the Executive Secretary of Nigeria Health Insurance Scheme (NHIS), Yusuf Usman could threaten health care delivery in the country, analysts say.
The crisis is on the coverage of the ailments by the enrollees under the scheme, which has pitched the executive secretary against the NHIS, HMOs and the Healthcare Provider Association of Nigeria (HCPAN).
Usman had also accused the operators of corruption to which they had refuted and accused the executive secretary of going beyond its bounds.
He had in a recent newspaper publication said that “Cancer is covered in patients that are enrolled with NHIS in the formal sectors.
He said, ”anyone that is enrolled with the NHIS and develops cancer will not be thrown out.
“If you enrol with NHIS and you have cancer, your case will be covered and I can say that authoritatively,” Yusuf affirmed
The executive secretary had also said that patients who have other tertiary illnesses like cardiac, dialysis and those that require kidney transplant are also included in the scheme.
But, Tunde Ladele, chairman, Health and Managed Care Association of Nigeria (HMCAN) the umbrella association of accredited HMOs refuted the accusations of corruption in NHIS operations as alleged by the Executive Secretary, a development analysts say has led to loss of confidence among the government overseer of the scheme and the operators.
Besides, Ladele said in an advertorial reaction to Usman’s publication that, “It is unfortunate that the executive secretary literally claimed he himself has been put under an HMO without his knowledge. The truth is he is a new employee in NHIS and has to use the HMO that all staffs of NHIS are using but to make use of his own choice of hospital. We are at pain to be painted black, warts and all for no apparent reason than bias and hearsay.”
Ladele further said that “nothing can be further from the truth that HMOs have taken over the function of NHIS regulatory functions.”
He also explained that “ it is important to clarify that only 30 percent of HMOs are involved in the running of the public sector social health insurance scheme for the federal civil servants.
”If 98 percent of fund has been made by HMOs, how much does this represent in Federal government fund on behalf of the Federal ministries, Departments and Agencies yearly payment to NHIS and amount paid to HMOs till date? How many are these HMOs out of almost 59 at the last count?
On the allegations that the HMOs have collected huge amount of money and nothing to show for it, Ladele further said, “Which money are talking about? a contract, a subsidy?”
Kolawole Owoka, immediate past Chairman, Health and Managed Care Association of Nigeria (HMCAN) in the same vein said “He is still new in the game and he’s not in the industry, he cannot just come in and destroy the industry – that is why we’re placing our advertorial to show that HMCAN we’re okay, if he have anything he can check, we are not asking him to spear anybody.
Owoka said “The new executive secretary of NHIS as a regulator, should go out there to look for those operators that are not good and use his regulatory power to either revoke their licence or sanction them, he cannot come out as a regulator and start painting everybody with the same brush, paint everybody black. People have been on this job before NHIS started.”
According to Umar Sanda, president Healthcare Provider Association of Nigeria, there is need for harmonious relationship between the regulator and the operator if the much needed healthcare delivery system is to be achieved.
“We solicit for harmony in the healthcare industry, there is no need exchanging accusations here and there, the NHIS been the regulator, HMO been the intermediary and we the provider, providing services should come together to move Nigeria health insurance forward, we want health insurance to improve and come together as one body by the time we throwing accusation here and there it will just be static because our coverage still low at less than four percent, He said “We hope very soon there will still be an opportunity for the three bodies to meet; we want it at a matter of urgent because we want harmony within the industry.”
Sanda further explain “if we come together we will be able to iron out our differences, there is a major thing that is affecting us right now especially we the providers, the recession is affecting our practice, the value of naira has depreciated and financially.
“We are very much affected but if we come together we will be able to present our own problem and be able to find solution to it and the quality of services will improve, we want harmony within the industry.” He added
