‘HMOs are Critical to Success of Health Insurance’

Martins Ifijeh
The Chairman, Health and Managed Care Association of Nigeria (HMCAN), Dr. Babatunde Ladapo has stated that the role of Health Management Organisations (HMO) is very important and critical to the success of the National Health Insurance Scheme in Nigeria.

He said when HMOs are provided with the enabling environment by the Federal Ministry of Health and NHIS management to perform its statutory role in the provision of healthcare insurance in the country, the present stagnation in the scheme will be a thing of the past.

Stating this during the HMCAN-Media Engagement in Lagos recently, he said, “every problem we have in NHIS in the setting of the scheme is failure of regulation. The regulator wants to be the operators, they want to register HMO, they want to register enrollees, but the law did not state that.

“The law is very clear that we the HMOs should be the keeper of the Premium collected, just like the insurance industry and the banking sector. If this and other sundry issues are addressed, NHIS will achieve its desired aim,” he said.

According to him, government need to put persons who are familiar with how health insurance work in the helm of affairs of the scheme.

“The way forward is for someone who has been in the health insurance to man the affairs of NHIS. Like for example, Emefiele of the Central Bank of Nigeria was the Managing Director of Zenith Bank, Lamido Sanusi was also the MD of First Bank, so why can’t someone who have been on ground for 20 years man the affairs of the NHIS? Most of our members are qualified to hold the position of Executive Secretary of the scheme, because we understand exactly how this thing works.

“This present Executive Secretary has been there for like six months now, and he has not grown the scheme by one person. Yet nobody is asking questions. He kept complaining that HMOs are the problem, and that if he has his way, they should have been removed. But he has forgotten that the role of HMOs is very critical to the success of the scheme,” he added.

He accused the FMOH, which is a supervisory ministry for NHIS for not effectively doing the needful, noting that the management of the scheme was making certain decisions which were beyond its powers.

“Presently there is no council in place at NHIS. It is the duty of the council to make decision, and then give direction on the day to day running of the place through the Executive Secretary. That is what the Act setting up the scheme says. That is when things can start working properly. But we have a sole administrator who can just wake up one day and decide on what to do without anybody monitoring him,” he said.

On his part, a Health Management Consultant, Dr. Tarry Asoka said the expected roles of HMOs within NHIS include collection of contributions from all eligible employers and employees; collection of contributions from voluntary contributors; render returns to NHIS council; ensure contributions are banked according to guidelines approved by council (NHIS Decree); among others.

But he lamented that majority of the statutory roles of the body were still not been carried out. He therefore advised that for the benefit of making the scheme work, the Act setting up the scheme should be followed to the letter.