Adesimbo Ukiri, the Chief Executive Officer and Director of Avon Healthcare Limited, with over 20 years’ experience across several sectors including banking, telecommunications and health. she spoke to BusinessDay’s OBOKOH ANTHONIA & MICHAEL ANI on several issues regarding access and the need for informal sector participation in the health insurance scheme. Excerpts:
When Avon announced its entry into the Health Insurance Market, the brand’s Unique Selling Point (USP) was to crack the retail sector. Four years down the line, how has Avon fared in this regard?
When Avon started, the retail sector was really the attraction for us because we looked at the Nigerian population of over 180 million and considered the fact that penetration was low, less than 3 per cent of the total population was covered. We also noted that the informal sector was larger than the formal sector in Nigeria.
Before our starting, Health Maintenance Organisations (HMOs), there were about 70 licensed HMOs and many of them had been in existence for about 10 years or more before we started.
However, none of these HMO’s was able to penetrate the retail sector of the market. When we came in, we contended with the fact that the HMO industry as a whole had a bad reputation in the minds of the people as people never believed that their services will be rendered to them even when they have paid because of the bad experience that they had with other HMO’s in the past.
It’s been 16years since NHIS industry began operation in Nigeria. From your position as CEO of Avon, are there any noticeable impacts that the industry has made vis-a-vis healthcare financing in Nigeria
The NHIS provided health cover for public civil servants at the federal level beyond that there has not been anything much. The good thing is that within the past few years even though the NHIS has not achieved much in impacting a larger number of people, it has however succeeded in raising the awareness of health insurance as several states have passed a law for health insurance plan
Government expenditure on health is totally insufficient and besides the money going to capital infrastructure is not even enough to buy equipment. The Federal Minister has brought some hope that he is going to rehabilitate ten thousand primary healthcare centres that will cater to more people.
However, it is high time we stopped seeing health as a social value rather we should see it as a business to invest in as we cannot continue waiting for the government.
Healthcare in America is probably one of the biggest business sectors. Our sector is about health financing, people will invest in any business that will give them a good return. Not only a good return financially but also by way of fulfilment because you are giving social goods.
We in the private sector, how much investment are we putting into the health sector? Also, individuals how they are supporting healthcare business in their area, do people use hospitals instead of faking it or do people go and consult professional medical practitioners rather than quacks.
These are ways in which we ourselves on an individual basis can help the health sector beyond the budget reallocation that the government has proposed.
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Avon’s recently introduced a new bouquet of health subscription plans specifically designed for the un-served Nigerians. What makes it different from the array of plans already existing in the market?
We met an advanced market where it is almost impossible to see people deep hands in their pocket to pay for something that may or may not happen.
Another challenge was the share distribution model. That is how to get into as many different people as possible and also how do you ensure that anytime they access the service they get a good experience
However, we have come up with a wide array of retail plan that follows everyone throughout their key stages in life. There are about six plans that would reach out to the many Nigerians in getting quality and access to affordable healthcare.
The Life Starter plan, with a very affordable plan of N20, 000 takes care of all general outpatient disease, covers both minor and intermediate surgeries, travel insurance. It is a plan that is mostly targeted at the young populace and that is why it comes at an affordable price.
The Couples plan is targeted at people who are into a serious committed relationship. It gives them free pre-marital health check-up like knowing your blood group, genotype etcetera. After 18 months on this plan, you are entitled to do a fertility test and maternity cover.
Life plus Plan: This has a wider coverage compared to the couple’s plan and the life starter
Premium Life: This is targeted at those who at the middle-aged; the plan offers a robust cover of an advanced diagnostic test, the extended benefit of annual wellness test.
Boss plan: This gives you access to the best hospitals in the country
International plan: This takes care of patients’ with-in Africa where their health care is top-notch. It also covers patients both in Nigeria and outside
At Avon, we looked at the real segment in the economy and came up with plans that will cater to their health needs according to how they can afford it. Also, we looked at the different plans for Small and Medium-sized Enterprises (SMEs) in ways they can afford it so that their staff can be productive a 100 per cent. We are also more than just an HMO as we are committed to looking after the health of our client’s staff to make them more productive.
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Kindly tell us your position on why most patients prefer to pay out of pocket for medical care rather than subscribing to a plan under the health insurance scheme?
The major reason people need to subscribe to a health insurance plan is to eliminate out of pocket payment because illness doesn’t warn us when it is coming and most people do self-medication, prayers and native medicine because of the money they will spend when they go to hospitals.
This makes them look for cheaper alternatives but imagine when they do not have to look at their pockets; it saves lives because most of the life-threatening illness when discovered early can be treated. Therefore the most crucial reason everybody needs a health plan is to eliminate out of pocket expenses hence our awareness campaign to the general populace. Take the money out and buy a health plan so that when any health issue arises, you do not need to look at your pocket before going to the hospital.
On the allegation that most hospitals prefer patient paying out of pocket, that was the case five to seven years ago but now the hospital has identified financially stable HMOs who pay their bills on time and in full as contracted. Most hospitals were doing that in the past because when they submit their bills, it takes time for those bills to be paid for and not only that, the bills will be slashed. But the pressure on non-performing HMOs in the last five years is huge but since we came we started giving more hospitals and enrollees the power to shout out any complaint, therefore, leading to a whole lot of positive changes in the sector.
Now hospitals prefer patient that the HMOs pay promptly. I can say categorically that there is no hospital you carry your Avon HMO card to and you will not get preferential treatment because we pay. The onus is on corporate organisations and individuals to do their research by talking to hospitals before buying any health plans from any HMO.
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How do HMOs regulate activities of hospital in terms of enrollee complaint against hospitals?
We have a department called the provider services which comprises of case managers who are doctors and nurses. We also have the quality assurance department which is full of doctors and nurses whose job is to accredit hospitals according to our standards before coming on board. They also do random spot checks on hospitals, so they can detect if the hospitals accredited still adhere to those protocols or not.
We also have disease management protocols and drug formulary, the disease management protocols is an agreed way contracted with hospitals on how the patient will be treated for primary diagnosis in relations to the laboratory investigation that needs to be carried out at each stage according to the world health organisation standard of treating the kind of illness.
Our staff go to different hospitals to make sure those protocols are followed. The drug formulary ensures that only drugs approved are dispensed to our patients. We also do random checks on hospitals pharmacy to ensure that expired or tampered drugs are not stocked. We also do random case file audit of both outpatient and inpatient. We also offer a random opportunity to patients on admission or discharged to share relevant information and experiences during the course of admission.
What makes Avon HMO health plan model different from its competition?
Avon managed healthcare plans give a level playground to all enrollees because we do not discriminate based on previous medical history, or new diagnosis, what we do at Avon HMO is to look at the totality of the enrollees and everybody will pay the same premium because we recognise that the sick people are been helped by the healthy people.
The model operates on you are your brother’s keeper. Because we believe that healthy people will also get sick someday and need to access the pool fund, we have seen different scenarios buttress the point. Health insurance is all about taking care of the health of the people.
What is Avon HMO plan towards achieving universal health coverage in Nigeria?
Universal health coverage is the dream of every country and only a few countries like Sweden, Netherland has achieved the feat, we can only achieve that with appropriate political will because the government needs to subsidise, many people below the poverty line can hardly feed hence they cannot even pay for healthcare.
Universal health coverage can only be achieved with an efficient and effective network of healthcare facilities. To me, the future of universal health coverage is still bleak but we need to look at roles of improving healthcare insurance to be more efficient and be a model HMO company that will attract foreign and local investors into the sector.
The second thing we are doing and we continue to do is to preach the importance of healthcare and the importance of people investing in their own health the way they invest in education and accommodation because it strengthens the ecosystem. We are also working with other stakeholders in the health sector to pass the right laws that will empower and equip the regulators to do what is right always so that they will always be at the table brainstorming on how we can finance the universal health coverage.
Universal healthcare coverage is a private-public partnership that will make it a reality. HMO needs to make more health plans available which are well regulated while federal, state and local governments need to deduct money from their workers for health plans and also make sure they subsidise health plans for people below the poverty level because they cannot pay. Nigeria needs to work hard on that journey to make it a reality.
