By Femi Ogunshola
When former President Olusegun Obasanjo launched the National Health Insurance Scheme (NHIS), now the National Health Insurance Authority (NHIA), on June 6, 2005, Nigerians heaved a sigh of relief.
The expectation was high that the scheme would solve the high healthcare expenditure burden of most Nigerians.
The fundamental principle that guided its establishment, as set out in Act 35 of 1999, is to ensure that every Nigerian has access to good healthcare services.
This is further amplified in the protection of families from the financial hardship of huge medical bills, be they civil servants or non-civil servants.
However, a look at the activities of NHIA and its approach to bringing the idea behind its establishment show a system struggling to deliver on its mandates, say some subscribers.
So, far, according to the Coordinating Minister of Health and Social Welfare, Prof Muhammad Pate, the Federal Government had enrolled about 750,000 Nigerians into the National Health Insurance Scheme.
“We remain committed to providing access to quality health for all Nigerians through the Vulnerable Group Fund and the Basic Health Care Provision Fund”, Pate said at a news conference in Abuja recently.
The Special Adviser to the President on Health, Dr. Salma Anas-Ibrahim presents an ambitious roadmap for the scheme and the larger health sector.
She said the government planned to health coverage to over 50 million Nigerians, especially the vulnerable and the elderly people by 2027.
While the government spreads the tentacles to enrol more subscribers, some of those already in the system say it is not meeting their expectations.
A civil servant who prefers anonymity is an enrolee of NHIA with Saffron Hospital Ltd. Abuja. Her numerous experiences with her hospital have left much to be desired, according to her.
Narrating her experience, said that in spite of the promise by NHIA of covering major sickness with its attendant deduction from her monthly salaries, such a promise has remained a mirage.
According to her, most times when she goes to the hospital to either collect drugs or treat typhoid or malaria, all she hears: “typhoid is no longer part of our services.
“We don’t cover typhoid; we only cover malaria, and at the end of the day, they only gave me painkillers, and because they don’t have the main malaria drug, I had to go and buy it”.
At the Limi Hospital, a private hospital under the NHIA, patients requiring services like full blood counts and urine tests are being referred elsewhere due to payment issues.
Mrs Funke Oluwafemi, an enrolee at the Limi hospital, had a troubling experience when she came for secondary care but was told that such care was under suspension.
When she contacted her HMO, Sununu, via a message on Whatsapp, the response was jolting, “Greetings from Sununu Health, apologies, Limi is not attending for secondary care; kindly inform them to send us a request for your referral to the national hospital.”
This, she alleged, has become the usual line by the health maintenance organisations, subjecting patients to harrowing experiences, even in emergency cases.
Mr Fortune Abang, also a civil servant, said that HMOs should be accountable to enrolees, adding that there should be collaboration between NHIA and the primary hospitals.
According to him, there should be an agency to check the amount received yearly or quarterly by NHIA, adding that this would help in bringing transparency into the management of health insurance in the country.
Fortune said: “I use Garki Hospital; many services are not covered under the schem such as scanning. Sometimes they tell you the blood test is not covered. The only thing we benefit from is the drug.”
Narrating his experience, Ahmed Ubandona, another enrolee at the State House Medical Centre, said patients often attend all the tests without being given drugs.
Most times, unpaid NHIA funds have left patients stranded without secondary services as enrolees under the NHIA face hurdles accessing secondary healthcare services through their HMOs.
Mr Ibrahim Abdullahi, an enrolee, said that the NHIA, designed to ensure universal healthcare coverage at affordable rates, is faltering due to delayed payments to participating hospitals.
He stated that hospitals affected by non-payment by the NHIA are redirecting patients in need of secondary services to government facilities, including the National Hospital.
A staff member of Sununu HMO, who requested anonymity, confirmed the suspension of secondary services due to outstanding payments from the NHIA, leaving patients in limbo.
She said that until funds were released patients would continue to be deprived of these essential services, adding that efforts to address the issue with NHIA have proven futile.
She said this had left both patients and healthcare providers in a state of uncertainty.
According to her, the situation underscores the urgent need for financial stability within the NHIA to uphold its mandate of providing accessible healthcare for all Nigerians.
In spite NHIA guidelines, many enrolees feel abandoned.
Their concern is that the NHIA percentage collected from enrolees is not reflecting on their civil servant salary or how much they collect, with speculations rife that it is more than 10 per cent.
An official of NHIA, a call agent who simply identified his name as Kabiru, said that if any hospital opts out for any services, under the operational guidelines, such a hospital has to inform the authority three months prior to the time.
He said that the hospital in question must write a letter. He, however, said NHIA has not received any such letter.
According to him, when hospitals not rendering secondary service have such a case, they should approach to their service providers to refer them to hospitals that render such services.
“Since the HMO said that they have not been paid, you will send me the person’s full name and phone number, so that I can put a call to the person and ask why he said that.
“We know that the authority normally pays them, they send joint bills to the HMO, and payment is made. So, I am surprised that I am hearing that the HMO are not been paid’’, the source said.
On complains that several health conditions were not covered under the scheme, the source said though malaria, for instance, was covered, the HMO could refer the patient to a specialist if he or she repeatedly treats the ailment.
“So, if the person has anything to do with a specialist, they can then send the person’s number so we can contact him”, the source told NAN.
He said NHIA has also advised HMOs to look at the merits of each case before refusing treatment for cases not covered under the scheme.
He, however, said such cases should be reported in writing, with a potential sanction for defaulting hospitals.
“There is this case of a hospital that we sanctioned for six months because of a matter that we felt they should have handled.
On the allegation that the HMOs were being short-changed by NHIA, the source said the Authority had always kept its side of the bargain.
“The NHI pays N750 naira per head per month. Let’s assume now that one hospital should has 1, 0000 subscribers that will be times N750.
“So if we multiply N750 by the 1,0000 subscribers we are giving that hospital in a month is N7.5 million in a month. I know that some hospitals have more than that number of subscribers.
“Let’s assume that someone is getting treatment for malaria or any other sickness. They cannot spend all of that money in a month. The NHI guidelines make it mandatory that they are paid quarterly.
“So N7.5 million times 3, they are getting N22.5 million in 3 months’’, the source clarified.
He advised enrolees to always get receipts once they make out-of-pocket payments and approached NHIA for refund.
The on-going issues underscore the urgent need for NHIA to stabilise its finances and uphold its mandate of providing accessible healthcare for all Nigerians.
Making the health insurance to deliver on its mandates will ensure that Nigerians out of pocket health expenditure will drastically reduce.
Pate acknowledged the weight of this burden saying: “the prices of drugs were high while less than 10 per cent of the population had health insurance, putting much financial burden on citizens to pay out-of-pocket for health.“ (NANFeatures)
