Some hospitals should not take up insured patients – Prepaid Medicare

For how long has Prepaid Medicare been a Health Maintenance Organisation?I have been in the health insurance industry for nine years. Prepaid is a national health maintenance organisation accredited by the National Health Insurance Scheme. It was put together by a group of young individuals interested in making health services available and accessible. It is […]

For how long has Prepaid Medicare been a Health Maintenance Organisation?
I have been in the health insurance industry for nine years. Prepaid is a national health maintenance organisation accredited by the National Health Insurance Scheme. It was put together by a group of young individuals interested in making health services available and accessible. It is about getting families, people in rural Nigeria to enjoy health services that everyone else enjoys. Prepaid Medicare started with private lives – that is, individuals and corporate organisations that want to bring their staff into health insurance programme.
In 2009, the MDGs started and that was our first involvement with NHIS. We were allocated Lapai Local Government Area in Niger State, and our mandate was to capture 33,000 lives—30,000 as children under five and 3,000 pregnant women. The MDG NHIS was instituted by government so that people in rural communities could have access to health care services and reduce the bad indices of healthcare we have in the country.
Prepaid was able to achieve full registration of lives by 2011, and since then we have surpassed the 33,000 given to us. We had to slow down at 45,000 in Lapai. The MDG NHIS programme has had its own problems. In 2012, 2013 payment was only made for three, four months. Two years ago, Prepaid started having formal sector lives — public sector, about 4,000, inclusive of principal and dependants. Our main stay has always been ensuring we work on our private sector lives, because we believe the private sector is still not accessed by the health insurance industry; the reason being that many people have not imbibed the culture of insurance.
People believe insurance is a scheme to get money out of people. However, this is a programme you will eventually use. You may not be sick today but when you are and you don’t have money in your pocket, you won’t be able to access care. What you pay as premium is a hundred times less than you need. If a person has a card, he has unlimited access to health care. Most of the time in hospital, they will give you first aid treatment, but beyond that you may be asked to pay something. But when you have health insurance, it is not so.
Apart from the formal sector, we are also involved with tertiary institutions to allow students have access to health care when they are in school and out of school. People assume young people don’t fall sick, but it gives parents rest of mind that their children are under some form of cover when they are in school, so they don’t have to travel across the country to ensure their children are well taken care of when they have health issues.
However, we have found some difficulties because students don’t understand the programme and the schools don’t want to either influence the coverage or buy into the programme. There is still very poor patronage. But there are prospects. NHIS is doing advocacy with education regulatory bodies so that the level of penetration can also improve.
We are involved in the Ogun community health insurance programme. It has taken off albeit it is very slow, making payments but some international donor agencies are involved to meet the shortfall of that particular programme. People in the communities make their payments into any form of collection they want, and HMOs come in to serve as technical advisers.
How has the industry been for an HMO like you?
Because of the low awareness or understanding of insurance, even talking about insurance and getting people to subscribe to policies is difficult.
You have to do a lot of talking before people buy into the services available. No matter how good your services are, they never buy into it until they see a need. Organisations have bought into it to reduce costs, and others have bought into it to protect their brand name, because they have a reputation to protect, such as in taking care of their staff.
Nine years is a long time to acquire experience. What strategies have you used to stay in business?
We cannot do the job alone. We have a lot of partners in community health insurance programme – CBOs, NGOs, international partners – who engage communities at local level. When you sensitise and educate them, they have a better understanding of health insurance programme and can speak for you. When you educate the stakeholders, it opens up the market for us. We have to match those who can provide the service to those who need the service.
One reason why the industry is not growing is that you find a mismatch. It is a matter of bridging the gap.
People complain about how the packages are run. Do you have separate categories for these complaints?
Different HMOs have different plans. For a plan, there is a banquet of services. Most times people buy health plan and don’t read the tiny print on their benefit package. It is easy for people to complain. They should first find out what they are entitled to. Give Nigerians a health plan, they don’t look at the benefit package, they look at the price tag and pick the lowest forgetting episodes when they will need higher plans.
What do you say about hospitals that shabbily treat people covered under insurance?
Not all facilities should be providing insurance. Some providers have pulled out because the burden outweighs the benefit. A big hospital with many clients may consider it burdensome taking on more private lives because they look at the wear and tear of the equipment, the hospital, the renovations they have to make. Yes, they are making the money but do they want to go through the process of doing those things that they have not budgeted for? For smaller clinics that don’t have enough lives, they want to be on health insurance because it increases the patronage and improves their baseline at the end of the year.
I don’t believe providers would intentionally not want to treat their clients well. There must be a reason for it. However, there are areas in HMOs that have caused problems for providers and there are areas providers have caused problems for HMOs. The patient is the centre. We should work together to ensure best services are provided these patients. People should speak out. When they do, these kinds of problems will reduce.
Most Nigerians don’t complain and the channels of complaint are always there. It is no good complaining on the pages of newspaper; there are regulators. I believe that the sky is the limit for Nigeria as a whole.
Presently we have 5 to 7% covered in insurance. Majority of Nigerians have not been covered. If we can achieve 70% coverage, the insurance industry will grow, the economy will grow in respect to healthcare. Health tourism will be a thing of the past because there will be enough funds to provide all equipment required to provide health care services and bring all Nigerian doctors specialised in different areas of medicine to come back to Nigeria.