By AYOOLA OLAOLUWA
The National Health Insurance Scheme (NHIS) is currently being rocked by allegations of poor services and undercutting Nigerians who signed into the programme, Business Hallmark findings have revealed.
The scheme was introduced by the Federal Government in 1999 as a social tool towards attaining equity in health service delivery.
According to the brains behind the scheme, the NHIS was meant to ensure a guaranteed pool of funds for healthcare, improve the efficiency of management of health resources, as well as to protect millions of Nigerians against unplanned medical expenditures.
Under the arrangement, participants pay a fixed amount monthly to the NHIS, depending on the package they chose. The funds are then released to Health Maintenance Organisations (HMOs) who then pay participating hospitals for treating those needing medical attention while NHIS regulates the participating hospitals and HMOs.
However, more than 22 years after its establishment, the health insurance scheme is experiencing hiccups, with Nigerians complaining of not getting adequate care and treatment from their hospitals.
For instance, several staffs of a public primary school in Oko-Oba, Agege area of Lagos owned by the state government, complained bitterly about the quality of service they usually get from a popular hospital based in Abule-Egba.
According to the teachers who spoke to BH, most of them in the school chose the hospital based on the recommendation of a few others who attested to its good services and able management. They, however, claimed that they have been largely disappointed with the services the hospital provides.
“I registered for the NHIS scheme in 2020 after the Lagos State government mandated all its staffs to enroll for the scheme and started deducting our monies, while also paying its own share of the contribution.
“I picked the hospital based on the advice of some colleagues who were personally using it before the state government made it compulsory for all its staffs to enroll in the scheme.
“Unfortunately, I am disappointed with their services. The hospital is not different from a public hospital. While the crowd you meet there are usually very large, it takes hours for you to be attended to.
“They don’t also have a standard laboratory and diagnosis centre. Most times, they still refer you to other private or government laboratories to do tests at our own expense.
“Some of our colleagues who chose Ayodele, County and Blue Cross Hospital, all in Ifako-Ijaiye, do not experience the same treatment. The hospitals bear responsibility for the tests done internally and those referred to other laboratories. I am considering changing my hospital to another one”, one of the teachers said.
Another member of staff who spoke to our correspondent disclosed that the hospital hardly give her drugs anytime she go there for treatment.
“I am an hypertensive patient and I often visit the hospital for treatment. But doctors always ask me during the visits whether my drugs still remain, while advising me to either increase or reduce the dosage.
“One day, I told a doctor that attended to me that my drugs are finished when he asked whether I still have some remaining. I thought he was going to give me the drugs.
“But I was shocked when he brought a paper and wrote the drug’s name on it, telling me to go and buy it. What is the essence of paying over N3,000 every month without giving me drugs to treat my ailments.
“The best I get from them are paracetamol and anti-malaria drugs which are less than N1,000. A pharmacist will render the same service and I will still have some change left from the over N3,000 deducted from my account every month”, the source who did not want her identity in print fumed.
Meanwhile, BH learnt that most of the staff have changed from the hospital to others, particularly P&G Medical Center based in New Oko-Oba in Ijaiye-Ojokoro area of Lagos. A source informed our correspondent that no fewer about of 11 of them have changed to P&G, while others either picked General Hospital at College Road, or the General Hospital in Ile-Epo.
On why they chose government hospitals despite the attendant bureaucracy and challenges patients patronising them used to experience, one of them told our correspondent that the choice of public hospitals was based on the free medical tests they get there.
“I once did a test in a private lab for N11,500; just one test. Most public hospitals don’t have complete or well equipped labs. Apart from normal tests like blood sugar level, malarial and typhoid tests, they often refer their patients to do expensive tests outside. And these tests come at huge cost which most Nigerians can’t afford.
“That is why many people pick public hospitals as their preferred NHIS provider. If you see anyone claiming that he or she picked public hospitals because they are the best, they are not telling the truth. The motivating factor is to benefit from their (public hospitals) exhaustive but free laboratory services”, the source claimed.
Also, many Lagosians who spoke with our correspondent on their experience with many hospitals under the NHIS scheme said they were not satisfied with the low quality services they usually get.
“I am with a telecommunications company in Ikeja, and our firm forced us (staffs) to subscribe to the scheme about six years ago.
“However, my experience with the scheme is nothing to write home about. It is one complain or the other. For the three or four months that I and my family patronised the NHIS accredited clinic, cheap and ineffective drugs were dispensed to us, while we were also assigned young and inexperienced doctors.
“At the end of the day, we had to revert to our family doctor because we were not getting the best care. As of today, over N1.8 million had been deducted from my salary as NHIS contribution without me getting value for the money.
“Yet, my employer has refused to terminate the arrangement. But I don’t really care. As long as I get good medicare, though expensive from my personal doctor, I am satisfied”, declared Tunji Bakare, a systems engineer with a telecoms company based in Lagos.
Another contributor who shared her bitter experience with an NHIS accredited hospital with BH, Ifeoma Agu, decried the poor services she got from her provider while the arrangement lasted.
“The hospital didn’t treat me well. Initially, I started with Bronze (Family), paying N12,000 monthly. Yet, I didn’t get the treatment I wanted. I was advised to migrate to a higher bouquet like Silver, Gold or Platinum.
“I picked the highest package Platinum, paying as much as N30,000 on a monthly basis, thinking that I would get better treatment. But apart from putting us in more comfortable private rooms, there was not much difference in the packages.
“I have to terminate the contract since it was a personal one. Though I now pay more, I do get excellent services. You can imagine if one million Nigerians pay N30,000, even N12,000. That is billions of naira. Yet, only about 10% end up in the hospital. Despite that, the hospitals treat us like beggars”, Mrs. Agu lamented
BH conducted a survey among Nigerians who subscribed to the NHIS. Out of the 50 respondents, only 10, representing 20% gave the initiative a pass mark, with 80% saying they were dissatisfied with the operations of the scheme
However, some of the accredited NHIS hospitals who spoke with our correspondent blamed the poor services rendered to patients on the failure of HMOs to pay their claims.
Out of the 20 participating hospitals that spoke with BH, 15, representing 25% claimed they have been incurring losses participating in the scheme
“I regretted participating in the scheme. Apart from HMOs delaying in paying my claims, they also often slash the claims presented to them, making us to run at a loss.
“For the scheme to achieve its objectives there is need to improve the financial payment system”, advised a medical doctor who did not want his identity revealed.