July 19, (THEWILL) – In line with its mandate, the National Health Insurance Authority (NHIA), says it is at the point of compiling a list of Health Maintenance Organisations (HMOs) and healthcare providers, which are either owing, erred or not behaving well before they would be sanctioned.
General Manager, Lagos Zonal Office of NHIA, Mr Olufemi Akingbade, gave the hint on Tuesday, during the Quarterly Enrolee Forum organised by the Authority in Lagos with the theme: “Governing Mandatory Health Insurance, Focusing On The Enrolee”.
Speaking at the forum, Mr Akingbade said that with what they have in the new Law as an Authority, NHIA has the full right to sanction healthcare providers and HMOs.
According to him, about ten HMOs were de-accredited from their list last year, warning that more may go this year.
He said, “With what we have in the new law as an Authority, we have to sanction providers, HMOs. If you look at our records, you will notice that last year alone, we de-accredited ten HMOs from our list. I know that, even this year some are going to go because we are already at the point of compiling those that have erred, those that are owing, and those that are not behaving well.
“We are giving them an opportunity because we have done another review this year, whereby we gave some HMOs three months some six months to be able to correct anomalies that we saw. However, if after six months, those anomalies are still there, we don’t have a choice than to de-accredit them. The same thing with service providers. We have the right to also de-accredit them.”
With health insurance being made mandatory with the new law, Akingbade pointed out that the expectation is for more enrolees to come on board.
“We are expecting more people to come on board. Those that are already here should spread the message about the benefits they are getting from the health insurance. A lot of them are not having to pay out of pocket. You find out that a lot of Nigerians are paying out of pocket at the point of care. And that is one of the things that the health insurance is trying to eradicate. You prepare for it, so that when you need care, you don’t need to bring everything again out of your pocket.”
On eNHIA automation, he said, “We are still on it and a lot of work have been done. I am sure they are waiting for the new Minister of Health to come on board because we actually want to do a proper launch of what we call the eNHIA. ENHIA has three components to it. We have the front end of it, which is the registration. We have the middle end to it, which is supposed to take care of the electronic medical records. Then we have the back end which is the claims processing. When all these things are processed, it reduces time of settlements between service providers and the HMOs at the end of the day and you are able to keep records for planning.”
The General Manager equally advised Nigerians not to wait until they are sick before they seek healthcare insurance, emphasising that “the reason why you should not wait is that when you are sick, it is the time you go to hospital, when such happens, then you pay out of pocket.”
Raising hope for the future, Akingbade commended government’s efforts so far, having created the Basic Health Care Provision Fund initially. He, however, disclosed that what they are trying to do now is to expand that Basic Health Care Provision Fund.
“One of the things the Basic Health Fund did from 2014 was to make into the Law, at least one percent of the consolidated revenue of the Federation to provide it as insurance for those that cannot pay. Now they are expanding it because they want to create a proper vulnerable fund. So we are expecting that the one percent will be expanded to be able to take care of more people which is the 83 million people we talked about. And if they are able to do that, they would be put into the vulnerable group.”
Also speaking at the forum, the Deputy General Manager and State Coordinator, Ikeja State office of the NHIA in Lagos, Dr Bethuel-Kasimu Abraham, confirmed that some healthcare providers have already been delisted.
Dr Abraham added that those affected may not come back in the next five years, as the Authority had already put a moratorium on them.
Abraham informed that “there has been an improvement in the sense that the number of complaints have shot up by a margin. When you have a fora like this where you empower people with knowledge. One thing you notice is that your complaints will rise became people now know what they didn’t know before the encounter with that inclusion of knowledge. And so they can now report. They see things differently which they see previously as normal. That is the feedback we got from the previous session with service providers and HMOs. This one is specifically for the enrolees.
The medical doctor advised those who have not yet registered to come on board, “For those that have not yet enrolled, that has this perception about health insurance and the agencies managing health insurance, I want to assure them of one thing. A complaint is not necessarily a negative thing A complaint means that there is hope that there can be correction. It means there is somebody that can make that correction. It also means that there is going to be feedback.
“Perception can be part of peoples experience. And when they have such experience, it can be easily generalised, but that may not be the case. We now have a streamlined process for having complaints and we follow it to the latter. However, we are now more transparent and we encourage those who have not enrolled to do so. Should they experience any negative thing, they should be willing to provide their details while making complaints”, Dr Abraham pointed out.
Meanwhile, the enrolee forum was organised to bring different levels of stakeholders together. It creates a platform whereby the Authority gets to know their grievances and to be able to pass message back to them on what they are doing right or doing wrong to be able to improve the system.
Anthony Awunor, is a business correspondent who holds a Bachelor of Arts Degree in Linguistics (UNILAG). He is also an alumnus of the Nigerian College of Aviation Technology (NCAT), Zaria Kaduna State. He lives in Lagos.
