Nahimah Ajikanle Nurudeen
The Healthcare Providers Association of Nigeria, (HCPAN) has called for the review of the National Health Insurance scheme Act 35 of 1999 by making health insurance coverage mandatory for all Nigerians.
The National President, HCPAN, Dr. Umar Oluwole Sanda made the call at a press conference in Lagos on Tuesday.
According to him, the Federal Government should expand the scheme with more innovative products such as Mobile Health Insurance, Public Primary School Programme, Voluntary social Health insurance, prison inmate insurance and others.
The suggestions he explained were part of the group’s reactions to guide the House of Representatives Committee on Healthcare’s proposed investigation into the activities of HMOs and Hethcare Providers for the past eight years.
He said while HCPAN appreciates the investigation as a welcome development, the committee should realize that the act empowers only NHIS as the regulator, policy formulator and main driver of the scheme.
He explained that the act provisions also made NHIS the collector, custodian, fund management and the sole engineering of the health insurance scheme programme.
Sanda denied the claims that the HMOs are shortchanging enrollees because, NHIS is the body that enrolls people into the scheme, accredits providers, licenses and accredits HMOs, designs health-care services procurement protocols as well as handling funds disbursements through the HMOs.
On the low number of enrollees, he maintained that NHIS is responsible for driving the scheme by ensuring wider coverage of more Nigerians into the programme.
According to him, as at 2014, only about 9million Nigerians were enrolled in the scheme which already covered 98per cent of federal civil servants, 7,285 service providers accredited and 66 licensed HMOs.
Sanda disclosed further that NHIS sets payment model for healthcare services provided in the primary, secondary and tertiary categories.
He said, “Primary services are by capitation at the rate N750/enrollee, secondary and tertiary services are purchased as fee-for-services at a rate determined by NHIS tariff. All payments made through HMOs, capitation is paid to the providers as a prepaid mechanism according to number of enrollees per facility. This is supposed to be paid two weeks before commencement of every month. Fund for FFS are held by HMOs awaiting arrival of claims from secondary and tertiary providers while HMOs are paid only 10per cent as administrative fee for the intermediary role.”
He said there is no such thing that as connivance with HMOs to shortchange enrollees because, “all monies paid to providers so far have been for various services rendered to the registered enrollees over the past nine to 11years of the scheme.”
This he said is why NHIS should give account of fund used for the service procurement so far when it account is audited.
On the treatment of enrollees, the HCPAN President said, “We wish to state categorically that this cannot be the experience of enrollees with our providers.”
Also, the immediate past of President of the association, Dr. Mrs Adenike Olaniba said everyone in Nigeria must be covered in the national health insurance program to make it universal.
She suggested that Nigeria takes clues from the United Kingdom’s health insurance policy as well as other countries it shares similar social economic structure with, such as Ghana.
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