NHIS must regulate HMOs, improve coverage – Otabor

Why hasn’t the NHIS achieve substantial coverage since it started? Since its establishment about 13 years ago, we have not seen much from the angle of the NHIS in terms of coverage: that is in terms of the number of people that are covered, as well as the scope of services that are covered. This […]

Why hasn’t the NHIS achieve substantial coverage since it started?

Since its establishment about 13 years ago, we have not seen much from the angle of the NHIS in terms of coverage: that is in terms of the number of people that are covered, as well as the scope of services that are covered. This has left majority of Nigerians out of universal health coverage and what that means is that people will have to pay from their pocket when they need to access healthcare, and that system does not encourage good health. 

Emphasis around the world currently is on health insurance where majority pay for health when they are still well against the few that would fall sick in the future.

What are the problems of NHIS?

Statistics show that less than 10 per cent of Nigerians are insured under NHIS-maybe six per cent, but the truth is that the actual data is not even available.

I heard the executive secretary saying that he does not have the statistics of the number of Nigerians that are insured under NHIS. If he does not have it, who will have it?

So what’s been done to address the low coverage?

In African countries like Rwanda and Malawi, we are talking of about 60 per cent and above. So I think the emphasis has always been on the formal sector. The majority of Nigerians are outside of the government sector and so they must have to look for a way to capture the informal sector: schools, communities, farmers in the villages, artisans and so on. It is only when you have a good number of Nigerians under this scheme that you can say you have a chance of providing efficient health care for those who are covered because you can have more funds in the pool to buffer the health system. Even the few that are covered, to a large extent, there is a high level of dissatisfaction among the enrollees because with a major illness, NHIS cannot handle it. 

At the end of the day, people end up treating only ailments like malaria and typhoid. But once its beyond that, NHIS shies away except for a few special tertiary intervention cases which most enrollees don’t know the criteria of selection.

Big surgeries are not covered, including treatment of HIV, cancer etc. There is a big gap. For the services that are covered under the NHIS, the tariff is so low that most private hospitals who see about 70 per cent of the citizens shy away from treating NHIS patients. Many times, they are treated like lepers; please permit me to use that analogy.

For the scheme to succeed and for Nigerians to be happy with it, the tariff must be reviewed because the tariff does not reflect the current realities in terms of the cost of treatment.

For example, if someone is involved in an accident and he has bleeding in the brain, he will need surgery. There are about 150 neurosurgeons across the country of over 180 million people. So these are rare specialties. The NHIS tariff for treating someone with blood in the brain is N75,000.

Meanwhile, an average neurosurgeon after draining blood in the brain will collect between N300,000 and N500,000 as surgery fee, not to talk of anaesthesia, theatre use, admission, oxygen, drugs etc. you can see where the problem lies. So what most private hospitals do is to push them to government hospitals. You know the problems there. 

I think private health insurance has come a long way to the rescue of people in the organised private sector. With the private HMO, nothing is cast in stone, you can negotiate tariff and reach a reasonable price.

With this scenario you have painted, how come stakeholders like you have not been able to present these kinds of issues over the years?

The health care providers can only do the best they can but they don’t have the voice that the press has. You are supposed to interview the patients and ask them if they are satisfied. If they are not satisfied, what is the problem and you write or talk about what is happening.

We have always seen a situation where you get to hospitals and NHIS-covered patients are kept aside. In fact, they are treated as second-class citizens.

That is what I have been talking about. No one would keep a first class passenger in an aircraft waiting and be attending to economy class. It does not make business sense. Hospital service must be paid for and there’s a limit that NHIS is willing to pay on behalf of the patient. 

In the UK, their equivalent is the NHS. It is funded by public funds. Everybody pays tax into the system and they render the best quality services. 

One major challenge against the NHIS expanding is that the Act which set it up doesn’t mandate state governments to buy into it. What is your take on this?

Well you cannot force health insurance on the states. We run a federal system. The state governments will have to key into it because at the end of the day, it will be cheaper for everybody. 

The leadership of the NHIS could take advocacy to the governors through the National Economic Council or the Nigerian Governors’ Forum. Peer review mechanism can also help convince those who are yet to see reasons to key in. The more people that we can get to come on the scheme, the more the funds available for healthcare and the stronger the scheme.