Q & A: "Why our Health Insurance Needs Restructuring"

  1. Dr Ayoola Sanu is the Medical Director Solid Rock Hospital in Ojodu Lagos State. An astute medical businessperson who says he grew his private practice for 25 years without a Bank Loan. He however, thinks the National Health Insurance Scheme (NHIS) meant to cushion healthcare financing, presently is unfavourable to all stakeholders.

How was the starting point of your medical practice?

After my MBBS from the University College Hospital, Ibadan I went in for my postgraduate studies in Anaesthesia. I had initially wanted to study obstetrics and gynaecology but it was not available the year I applied and instead, I opted for Anaesthesia.

Afterwards, I went to work with Dr. Duro Soleye for seven years in his hospital at Ikeja. He had a business outfit connected to his medical practice. It was from him I learned how to do business with medical practice because I knew I was going to set up my practice and not work for government.

While working at Duro-Soleye Hospital, I did some business aside my medical practice, servicing Local Purchase Orders (LPOs) and soon a breakthrough came for me when I did an export for Cadbury Nigeria through a friend who was then the Procurement Manager.  It was an export of equipment for the company from which I made good profit. Thereafter, I set out to look for a location to set up; and we landed in Ojodu, opposite Federal Road Safety Commission (FRSC) compound.

God has indeed been faithful as we have grown from there by his grace until where we are today which was completed in 2008.

The name, “Solid Rock” was by a divine revelation; it was five years after we named our hospital, a Parish also came to choose the same name and it would seem we copied the Church; rather, they copied us because, it is also divine.

Anaesthesia is not particularly lucrative as a practice to stand alone, not all. The service is not like other specialties because you only gas patients for surgeons when they need you; nobody will come into a hospital to say I want anaesthesia treatment. It is only when there is the need for surgery that you become relevant. While working at Duro –Soleye I practiced as a full General Practitioner but always had at the back of my mind to set up my practice and therefore I got myself involved in virtually everything.

What were the major challenges encountered in 25years?

The challenges are no doubt enormous and in every area. There was the need for good doctors as one cannot work on one’s own, and by God’s grace, we have had virtually good staff and top-notch nurses and others. I told myself I was not going to build the practice around myself and to the Glory of God; there are people who are helping to build the hospital whenever I am not around. My desire is to have the practice go beyond my generation.

Apart from staffing, financing has equally been a major issue. In this our environment, the nerve to take a loan as a medical practitioner is not there. In the Medical School, no one teaches how to build a practice taking loans. The teaching was to focus on the trainings so a lot of us never had the nerve to go for loans to build our practice. I thank God I never had to take serious loans burden. We have grown in our own small ways. Interest rates on loan in this country is killing. You find Bank officials sitting in their cosy offices while those who get the loans are busy running from pillar to post to make the interest and still repay the loans.

Aside these two, running cost on the hospital is also a high issue. We run virtually on diesel and generators and maintenance is huge. For instance, in this neighbourhood, power supply used to be erratic and over the years, we had to acquire three industrial generators in addition to inverters for backup.

Without taking loans how have you been able to sustain the hospital over the years?

At the time we started some 25 years ago, there was still a little bit of money around and people could take care of their medical care. When we started, it was mainly more of private patients who could pay and over the years, we began to have corporate patients. That means initially, we had about fifty-fifty of private patients and corporate and the cost of consumable was not so high as many could still pay while only a few would owe.

Nowadays, with the recent development on National Health Insurance (NHIS), we now have the Health Maintenance Organisations (HMOs) as go-between and things have changed drastically. The HMOs are now like the “middlemen” in insurance who have gone to source for the business at their own terms that we are not privileged to know exactly what they collected. Nevertheless, we know that what they pay the provider is peanut and we are complaining. That is the state, which we have found ourselves. We do not have a choice other than to comply or go along with them. The patients too are not happy because the HMOs are undermining them.

The HMOs are cutting cost just to win clients. They lower standards, which at the end of the day they are not happy and the clients they are serving are not happy as well. At the end of the day, it looks like they are short-changing themselves to the detriment of the patients ‘care. That is why the system is not fully working.

For me, medical practice is a slow business; not a money spinning business. It takes time for money to build up. Apart from taking a small loan to buy an ambulance, I have not really taken a loan.

With the recent challenges facing NHIS, has this affected your patients’ patronage?

Yes, in way because many of the HMOs are now defaulting. It has always been like that but it has now become worsen. On paper, what the HMOs owe the hospital is huge and we know some will later become bad debt as some of them are already closing up. When an HMO closes shop, your money s gone! The best thing is to get one’s money on monthly regular basis.

When a patient whose HMO have been suspended comes around and you tell such a patient he or she cannot be treated, the reaction is often that of anguish and if such a patient could afford they pay out of picket else sometimes resort to begging and all that. It’s distressing for us that’s why we have lots of our money hanging out there. Just a few of the HMOs are doing very well. It will do all of us a world of good if the Scheme is modified and restructured to correct so many imbalances that have bedeviled it since it was launched. As a matter of fact, the NHIS deserves to be upgraded to accommodate the realities of our time.

What do you have to say about the involvement of financial institutions in running health Insurance yet they are not doing too well?

You know Bankers often want quick spinning return but health insurance is not like that. Banks are good at making their profits from forex, importations, loans etc Going into healthcare insurance or healthcare financing is not really a bad business for Banks. If anything its good business. What I think is that these Banks need to do some research and come up with more dynamic ways to market and sell healthcare financing as well as make it good business for themselves.

They have a body and they all must come together to agree that they cannot do the business beyond certain level or standards. The HMOs too are not a very strong body likewise the NHIS as a regulatory body is not firm enough.

What are you giving to the Community to celebrate 25 years?

Since we have been here inn Ojodu, the most common ailments we have seen are Malaria and infections. Malaria which is parasitic and bacterial infections due to the environment are two of the common reasons people visit our facilities. Though we equally offer child care and maternal deliveries amongst other.

But for the anniversary, we offered free medical outreach and free health checks and counseling  to enable as many members of the community benefit from knowing their health status as well as seek medical attention as appropriate.


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