Less than 10% of Nigerians are covered by health insurance – ClearLine

Do you think Nigeria is on the right track in health insurance management scheme?Health insurance has been in the pipeline since 1960. It never really took off until the time of the late General Sani Abacha. It was however General Abdulsalami Abubakar and former president Olusegun Obasanjo that rolled it out in 2005. It was […]

Do you think Nigeria is on the right track in health insurance management scheme?
Health insurance has been in the pipeline since 1960. It never really took off until the time of the late General Sani Abacha. It was however General Abdulsalami Abubakar and former president Olusegun Obasanjo that rolled it out in 2005. It was made compulsory for federal civil servants and their dependants. However, a few of us have been in the health insurance business as far back as 1997. We were not calling it health insurance then because of the word ‘insurance’ which people associate with fraud: that it was when they wanted to make claims that the companies would start dodging. Some people again ascribed it to calamities, asking why they should insure their lives against calamities when God is there for them. So, what we were calling it was managed care and it was just a vehicle for health financing.
The World Health Organisation (WHO) has been talking of a percentage that has to be set aside for health.  As part of the universal suffrage, again health is one of the basic conditions; when you talk of food, housing, people say they will talk of health first and by the time you are talking of health, concomitant things go with it – good housing, portable water, energy and so many other things associated with health.
Now, immediately Nigerians embraced it, we had a lot of work from WHO and IFC, because they are international finance organisations. To make sure these things work, the regulator is there on one hand, the National Health Insurance Scheme (NHIS), and we are the promoter because it is a Public Private Partnership (PPP) initiative and the third leg are the providers – the hospitals and health care centres.
What is ClearLine’s experience in providing managed health care services before NHIS programme and now?
ClearLine is a national health maintenance organisation approved by the Federal Government to underwrite health insurance in Nigeria.  With over 2000 healthcare providers nationwide and eight (8) zonal offices, we are poised to offer healthcare services to employees and their families anywhere in Nigeria.
ClearLine International is the most well-liked option to achieve affordable health insurance. We assure the lowest priced health plans with a health management system. We offer a managed care type of health insurance that is intended by and large for early detection and anticipation of main sickness. By owning our policy you are prompted to acquire regular check-ups so as to notice any trouble that you might have in the early stage.
Well, I have mentioned this before during a media interview, that this is the only country where you need to convince people about what is good for them. I created a scenario where I said the sobriety that is associated with you when you go to a morgue in terms of the number of people that are dead, their age and in fact the life expectancy in Nigeria; the infant mortality rate, maternal mortality and morbidity, when you take all those things into consideration and then you look at the general economic problems in the country, if indeed we can create this sub-health financing system in which, irrespective of whether you are poor or rich, you are entitled to health cover, it is the best thing that can happen to us.
 I always use the word ‘paradigm shift’ because whether it is from left or right; or when a priest in my church prays that people should not fall sick, I will keep quiet while some people will say amen. In my mind I say well, if people don’t fall ill how will I eat? But now that we have a financing system where some money is kept in a pool which is used to treat people irrespective of what that ailment is, when the priest prays that people should not fall sick I am the first to say amen. I will pray people do not fall sick so that I don’t use it. But that is not just it because falling sick is a reality.
In fact the percentage that people bandy around, that in about 100 people only about 20 per cent will fall ill is untrue because sometimes it can be as high as 60 per cent of the population that falls ill. I am not even talking of major epidemics like if Ebola gets into a community. WHO was talking about 90 percent mortality rate for Ebola. Although they are crediting Nigeria with less than 30 percent dead but the truth of the matter is we don’t want anybody to die.
The experience then and the experience now, therefore, is that of paradigm shift and as I said, the number of lives that are covered for now many say is insignificant in the sense that the Health Insurance Act has made it compulsory for you to have one health insurance or at least be able to have access to health insurance. We are praying that the bill is passed because, by the Act itself, certain amount of money will be made available for services.
Some say about N1.3 trillion per year from government cover. So, when we were doing it alone, it wasn’t as good but when ex-President Obasanjo said now I am putting this money down and everybody should be covered, that changed the face of everything.
Why are non-working class people not covered by health insurance?
If you look at the NHIS, the Act has made it compulsory. We have been practicing it and we think by now we have learnt that we need to be able to do certain things right and put them in place. The coverage and the awareness are erroneous in terms of how much is needed for people to be aware. We still have a long way to go in terms of advocacy I have no doubt about that. Newspaper or other media platforms will say that they want to propagate health insurance but they want money and it’s not small money. We expect that everybody should be partners in progress; we should all be talking about it. The NTA should devote some time on sensitising people on NHIS so that some of us can talk. But they expect to be paid because the media rely on adverts. I have no quarrel with that but that’s how it has impacted on what people should know; how much can people afford, and how many people can afford what? Less than 10 of Nigerians are still covered.
We have a new executive secretary at NHIS. I am not doing public relations for him but I think with the enthusiasm he came into the job, with the knowledge of what is to be done and the integrity he has brought to the place, it is not going to be business as usual; premium is not going to be about keeping money in fixed deposit and getting kick back. Those premiums are to be used, reserves are to be used to cater for people.
How will you rate quality assurance control measures of HMOs in Nigeria?
We are pioneers in managed care health services; before government acted we have actually set up a group called Health and Managed Care Association of Nigeria (HMCAN). We are careful not to put insurance there. We are praying that all HMOs join the group because entry is free and exit also free. It is not compulsory that you are a member. What we actually set out for is to self-regulate ourselves.
A lot of people now see HMO business as lucrative and they just set up HMOs, even non-doctors set up HMOs because you are free, it’s your money. So, if somebody comes into the HMO business without that background, I am not saying that if top bank managers who are accountants, who are managers put their money it won’t work especially in HMCAN, their valuable contributions are unquantifiable.
And on capitation, the reason we are taking capitation is that we are giving guarantee to providers in terms of taking risk of an advance payment on so and so.
Do you think the health bill addresses HMO operations and some of the abnormalities in the system?
 We have made inputs either as guild of medical directors, or NMA and HMCAN which is for managed  care providers but the beauty of the bill is that the social aspect that I mentioned  is a bit tied to that. The N1.3 trillion that the NHIS has suggested is to provide health care for all Nigerians irrespective of their status; whether you are working or not everybody must be covered.
What the health bill is saying is that the government by Act of parliament is meant to make certain commitment to health care delivery.  The politicians however are looking at the tangible things not the intangible projects and that has made it a bit difficult
Do you think NHIS has done enough in the recent announcement of the licensed or certified HMOs in the country?
As I said, there is a new helmsman who seems to understand our job. The fact actually is that the HMOs are not enough to look after the population. Initially we were talking about 77 HMOs and after re-accreditation it has come down to about 44 or less.
So, a new scheme is coming up. I think about 30 to 40 per cent of Nigerians will be covered by the end of the year. The re-accreditation has now taken a look into how you meet up with your obligations; how effective are you.
Also, there are no mushroom HMOs because they are in three categories – the national, zonal/regional or state HMOs. It will be wrong for anybody to say or classify any HMO as mushroom. They are not, they are new but the potentials that they will be great are there. At ClearLine, our experience is different; we are respected by our peers; we have corporate governance, we are very quickly reactive to claims, we don’t even joke with capitations but sometimes in the case of verifying claims it makes it a bit delayed but we don’t joke with it.