Immediately after his appointment as the Executive Secretary, National Health Insurance Scheme (NHIS), Professor Usman Yusuf was quick to givemake known his candid observation of what he thinks are the challenges bedeviling the scheme and how he intends to fix them
One of his observations when he met with one of the key players the Health Maintenance Organisations (HMOs) was to tell them that their activities have been fraught with fraud especially in their dealings with enrolees.
According to Yusuf in a Press interview, ” I summoned all the HMOs to Abuja, where I presented them with what they have been doing; essentially what HMOs did was to corrupt the system in their favour. They reneged on their contractual agreements with the enrolees and the NHIS.
“We, the NHIS, give them money on behalf of enrolees three months ahead to pay to hospitals, but they don’t pay the hospitals or usually issued dud cheque to the hospitals. Therefore, I told them it is not going to be business as usual. Any HMOs found wanting, his licence would be revoked”.
This assertion however has not gone down well with the care managers who think the Executive Secretary (ES) lied and was obviously speaking from an uninformed perspective on the workings of the Scheme and the Act establishing it.
According to the Chairman, Health and Managed Care Association of Nigeria, (HMCAN), Dr Babatunde Ladele at a recent Media dialogue, “The new Executive Secretary at NHIS Dr Yusuf Usman is equating this prepaid scheme as a fraud and it is very important we try to correct that impression in the minds of the public.
“He said we are paid three months ahead on behalf of enrolees but we do not pay the hospitals, that is not true.
“For example, yes, we are supposed to be prepaid for three months by the Scheme and we are supposed to be paid two weeks to the preceding month but here we are just been paid in February, for the first three months of the year. You then ask, so what happened?
“The money had been taken out from Treasury Single Account (TSA) since December 2016, kept somewhere then, its being distributed in parts and bits. It is a big challenge. We are fighting this system not for ourselves but for the sustenance of our country and our people”, lamented Ladele..
Ladele noted that HMCAN which is the umbrella body administering and regulating the affairs of the HMOs has been in business for two decades and have garnered sufficient experience to run the country’s health insurance saying, “its unfortunate that we are now been labeled as frauds and as scammers”.
But why would the HMOs be called Frauds?
You know, before the era of managed care which is Health Insurance there was what we called Retainership System. If you know the paradigm then, it was: the more you are sick, the more the hospitals get patronage..But there is a paradigm shift now that you put some money in prepaid account and when you are sick you go to the hospital to receive quality care.
If you don’t fall ill, your money is used to subsidize care for some other people’s treatment. So the paradigm have shifted and some people are now thinking of promoting preventing health rather than curative health. In other words, these HMOs are all about the place telling you that this premium you paid would be managed properly for the few that would be ill.
Generally some companies don’t like that because there used to be a lot of red seeking, moral hazards, we don’t want to say corruption, but that was what it was.
But then, this (prepayment) has come to address the misdeeds, the ills in the retainership system and so the people in the retainership system wouldn’t like us.
The HMOs have come to replace that and so those in the retainership system would naturally not like us. The workers themselves don’t like us; then the regulators (NHIS Managers) thought this should be like NNPC, it is our own money and we can do as we like; so they see us as interlopers who are coming to disurb their dealings, so they don’t like us. So if you say that is a legitimate reason for not liking us well, you have your view.
In the rationale of Dr Ladele, “HMCAN is supposed to be the regulator or the promoter of the business not NHIS”.
According to him, “We are one of those that midwifed the social health insurance scheme which is just one scheme out of so many others. We also run the private organised scheme, individuals schemes, families scheme where people can just walk into a HMO office for a plan”.
If you look at the population of the organised private sector in Nigeria which is the only one we can upload, and if you look at the population of the federal public servants in Nigeria, that is the one we can upload, its still about 5% of the whole population of Nigeria.
So its foolhardy for anyone to say that money has been collected for about 170m people by us and we have only uploaded 5% and kept the remaining money. That’s mischievous.
Talking about gaps in the Scheme and reaching the vulnerable:
As I stand here, there is what we call adoption trick which is reaching out to those who have to help those who do not have. Dangote can say that in Dangote village there are about 250,000 people that are enumerated to be vulnerable and so I want to pay for 10 years sum of N,000 per person per year and they start receiving healthcare that day.
Now, the Federal Government was talking about some vulnerable who are to receive N5000; I can assure you if I have that nominal roll today, if they are say 10m and if they can match that sum in a pool for NHIS now, with another N5000, we can give those vulnerable a package. Those same people can be uploaded today with the HMOs. We need to have the executive power to be able to do this.
The vulnerable are there but they need to be enumerated, we need to know how many there are, what are the criteria to use for that? Lessons have been learnt by us and we are in a position to do that easily, but you are not allowed to do that. The NHIS Secretariat is saying that is their job and they are the ones to register; even the ones we registered, they are saying they are the ones to give them identity cards and so they put obstacles so that monies collected just stay in the bank. So you see, a group is seeing how to upload, another is just growing the fund that is actually the main issue here- growing the fund and growing the business
The way forward is simply to get someone very knowledgeable to be the Executive Secretary..You may ask why cant one of you here be? This is because someone who already runs the business from the managed care perspective is tested and can do it as he or she knows the system.
The Executive Secretary of NHIS should be a Health Economist, an Insurer, an Accountant, at least someone who has been in the knowledge of business management who knows the objectives and the deliverable and if he is unable to do this, should be kicked out of the place.
The person there now has been there since July 2016, he has not grown the Scheme by one person and nobody is asking questions. Yet he is saying HMOs are his problems. If I have my way, he should have been removed.
Every problem we have besetting the NIHS in Nigeria is failure of regulation. The regulator wants to be the operator, wants to register HMOs, the Provider wants to register HMOs and enrolees, want to do the identity cards of enrolees and so on, yet the Law dd not state this. The law is very clear that we should be the keeper of the money.
We have always complained and you know the FMoH as a supervisory ministry has not been effective, they have not been doing the needful there.
There is no council in place for instance. The Council should naturally give direction, take decisions on the day-to-day running of the Scheme through the Executive Secretary and then to us but right now, we have a sole administrator who wakes up daily to do whatever he deems”, Ladele regretted..