As out-of-pocket payment for healthcare constituting over 90 percent of private spending and less than 5 percent of Nigerians covered by health insurance (both in public and private sector), this development has left majority of Nigeria’s 160 million people without health insurance cover.
While this has created huge market potentials for Health Maintenance Organisation (HMOs) in the country to design health insurance products to achieve universal health coverage, Avon HMO is set to grow its market share in Nigeria’s health insurance shape through product development targeted at individuals and families in addition to its existing suite of health plans mostly aimed at small businesses and larger companies.
In an interview with BusinessDay, Adesimbo Ukiri, managing director/chief executive officer, Avon HMO explained that while out-of-pocket payment for healthcare still dominate the nation’s healthcare system due to misconception and lack of information on health insurance, health insurance is designed to facilitate fair financing of health care costs through pooling and judicious utilisation of financial risk protection and cost-burden sharing for people, against high cost of healthcare through prepayment systems.
“Healthcare providers should work with health insurance providers to provide a solid platform that would deepen health insurance cover. This is a way health care providers can help promote the scheme. We must raise the bar of qualitative service delivery and ensure enrolees’ satisfaction towards accessing health plans which they are enrolled into,” Ukiri said.
Giving a synopsis of Avon health plans, Ukiri stated that the array of new health plans were designed to accommodate a wide range of Nigerians, ensuring adequate coverage and prevalent ailments found in the country with emphasis on providing quality care. The Avon CEO explained that Avon Access Basic plan is priced from as low as N15,000 annually as premium which can be purchased on behalf of household staff and similar service provider.
“The plans developed in conjunction with international partners are for those who travel frequently and want peace of mind about t healthcare option as they provide international coverage. The new plans come on the heels of the announcement that Avon HMO has been licensed/accredited as a national HMO with share capital in excess of N400 million which means that it can provide private health insurance plans as well as the government plans irrespective of the region,” Ukiri explained.
She continued: “These schemes include the formal sector programme, the voluntary contribution health scheme, maternal and child health project, tertiary institution social health insurance scheme for university students and the mobile health plans. Our commitment to achieving the goal of universal health coverage and to provide consistent and quality healthcare to Nigerians is clear for all to see. Ukiri noted that Avon HMO works hand-in-hand with providers to ensure that patients receive the best of care.
According to her, “Patients under the Avon health plans are treated in line with the World Health Organisation (WHO) disease management protocol. Our focus has remained quality assurance-each week, our case managers personally visits an average of 75 percent of all enrolees admitted to hospitals and over 98 percent of our hospitals adhere to the drug formulary we provide thus ensuring that effective drugs are given to our patients.
“Capitation is paid to hospitals before the first date of every month and all claims are processed and paid within 30-45 days. All complaints are acknowledged and resolved with the turn-around time for specific issues being as quick as 15 minutes.” Sharing his experience, Tunde Ajala, a staff of Bank of Industry said “I am impressed with Avon HMO especially with the level of responsiveness of their staff to issues and complaints. They have shown a high level for knowledge in the industry.”
A peep into Nigeria’s healthcare system reveals that over 70 percent of Nigerians outside formal sector, i.e. most of informal sector and rural communities do not have health insurance. Their inability to take part in risk pooling and solidarity schemes endangers them as they remain unable to access healthcare readily.
Several African governments have called for the expansion of insurance-based healthcare financing, to raise additional revenue to fund the cost of healthcare provision as well as diminish financial barriers to obtaining health care at the time of illness.
With an additional $18 per capita needed to provide necessary subsidies to bring over 70 percent into the risk pool, alongside an appropriate benefit package to address the health related millennium development goals (MDGs) and access to emergency & trauma care, industry experts believe that unlocked demand will necessitate a significant investment in Nigeria’s healthcare delivery system, both public and private, and across various level of healthcare.