When Health Insurance Becomes Unattractive in Nigeria

In this report, Odimegwu Onwumere writes that there are loggerheads surrounding the Health Insurance scheme, causing intricacies in the areas of regulation and implementation, thereby creating loopholes for funds to go down the drain

A clash of interest has been brewing between the National Health Insurance Scheme (NHIS) and the parent body of Health Maintenance Organisations (HMOs) in Nigeria, Health and Managed Care Association of Nigeria (HMCAN).

A seeming fraud has allegedly been exposed in the Health Management Organisations (HMOs) by members of the House of Representatives’ Committee on Healthcare, early March this year, to the tone of N350b.

Irked by the shoddy picture, Chairman of the Representatives Committee, Chike Okafor frowned that the money in question was the eventful efforts of Nigerians in making the National Health Insurance Scheme (NHIS), an initiative of the federal government since 2005 after the Health Act of 1999, was made. Okafor therefore advised the NHIS to hold back from funding HMOs till examination into the matter was completed.

The federal government had although convinced the citizens that there was going to be NHIS monthly capitation under the National Health Insurance Scheme Act Cap N42, Laws of the Federation of Nigeria, 2004, meant to actualise the universal health coverage for the citizens but especially for children, women and the vulnerable in the society, through inexpensive cost and diverse prepayment systems. This was after the institutionalisation of NHIS in 1999 via Decree (now Act) 35 of the Federal Government of Nigeria.

Owing to the fact that health insurance is regarded as one of the most influential insurance policies, the NHIS was given a mandate to see that Nigerians did not lag in their overall health concern. But this exquisite initiative might have lost its focus as fraud and irregularities have supposedly been characterising the effort to give Nigerians a befitting health insurance.

Experts judged that there was a glaring misinterpretation in the way the health insurance has been handled on the part of government officials that hypothetically wanted to implement and regulate. The experts were consequently calling on the authorities for a talk in order to take a stand, given what the law has said. They believed that the government should not be the implementer of the health insurance and as well, as the regulator. In their effort, they wanted the government to come in as a regulator whereas the implementer would be the HMOs.

Speaking to newsmen on the issue in February, Prof. Mustapha A. Danesi, a consultant physician/neurologist at the College of Medicine University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH), said, “So at present the government seems to dabble into implementations rather than keep strictly to regulation and I believe it is in the interest of everyone to make sure that government keeps to its role as regulator and facilitator.”

In the cause of investigation, Mahmud Yusuf, NHIS Executive Secretary threatened to resign when the Pandora’s Box was discovered in the health insurance agency and he did not sing a different song to that of the Representatives, saying that the health insurance agency has not lived up to the responsibility it was formed. Yusuf said that not upto 5 per cent of Nigerians have been covered by the insurance scheme as against 60 per cent that was the nomenclature on ground at the formation of the health insurance agency.

Given the slapdash practices in the way funds meant for health insurance have been handled, some private health organisations in the country had earlier raised their voice in the way remittances were made in the NHIS monthly capitation. Some private organisations in a state like Plateau State made this known. In February, Chief Medical Director of Sauki Hospital in Jos, Dr. Daniel Gana, who was a former Chairman of Nigerian Medical Association (NMA), Plateau State Branch, was angst-ridden.

Gana said that the federal government has only been keen in staying at the NHIS office in Abuja, but allowed other individual health and other organisations to totter. Gana’s words were that some organisations that include Health Maintenance Organisations (HMOs) were paid up front, every quarter, by the federal government. Literarily, Gana’s statement suggested that hospitals nationwide hardly get their salaries as at when due. For instance, checks revealed that as at February 24, 2017, no hospital across the country received their salaries, making “what the hospitals are doing now as just humanitarian services.”

There are obviously many challenges facing the health sector in the country. The 2017 budget of 4.15 per cent for health, for instance, is the fraction of 3.65 per cent was in 2016, as against 15 per cent WHO and African Heads of State declared for countries healthcare in a meeting at Abuja in 2001. The federal government was oblivious or it knew but pretends to shy away, that health insurance has been hardly penetrated in the country given its unconcern attitude to the health sector.

Pundits in the health sector like the Chief Executive Officer of Novo Health Africa Ltd, Dr. Dorothy Jeff-Nnamani, said, “with the objective of providing healthcare delivery solutions across Nigeria and internationally through collaborative partnerships. In a public presentation in 2015 the government has not really made the citizens to understand what insurance really is. “

Jeff-Nnamani was of the opinion that aside the health sector, the citizens were still aloof in the understanding of insurance in its entirety. Manifestly in a religious country like Nigeria, the source added that majority of the citizens don’t agree in preparing for the unanticipated circumstances that might befall them hence the churlish for insurance. On the assertion that the federal government has only been sitting at the NHIS office in Abuja, Nigeria’s seat of power, to supervise the health insurance scheme, the source added that federalism has been part of the culprits besetting the health insurance.

The highlight of this is that the federal government insures public servants in its employ, but the state governments most times do not follow up, thereby not relieving their employees the insurance they needed. In a nutshell, the specialists believed that the authorities have made health insurance unattractive to the citizens in a country known for nepotism. Those who know better were of the view that health insurance should not have any barrier in how people access healthcare.

While fielding questions to newsmen in January this year, Danesi said, “Nigerians do not need free health but free access to health. Free access to health is only available to those who have a lot of money.” Danesi had a view that lack of finance was not only the barrier in accessing healthcare; many people that had the money hardly get healthcare as at when due.

In a quest to proffer a solution to resolve the crisis rocking the Health Insurance scheme, Danesi added, “Regulation means, make sure that the laws are implemented and make sure every accredited HMOs are quality HMOs, and make sure that accredited health care providers are quality providers. Those are regulatory issues and make sure that the money that is paid is properly kept and disbursed to the HMOs in order to pay the providers and so on, and that is facilitation. If we are housing the money that is paid, disburse it as fast as possible so that there will be no hitch in the implementation.”

The source, however, frowned at the situation where a patient lineup in the hospital for hours to see a doctor; something that ought to be easy for the patient. Adding, it stated that in a state where free access to health is fad, it means that a patient sees the doctor on arrival to the hospital and not need donkey hours to see a doctor. This is even as a Senior Director for the Health, Nutrition and Population Global Practice at the World Bank, Dr. Tim Evans, said, “Universal health coverage is an essential ingredient to end extreme poverty and boost shared prosperity within a generation. Putting people’s health needs ahead of their ability to pay stems poverty and stimulates growth.”

It is believed by connoisseurs that the only way to get free access to health is through health insurance.