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NHIS: 10 million Nigerians to lose cover as HMOs, hospitals’ feud deepens



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More than 10 million Nigerians enrolled on the National Health Insurance Scheme (NHIS) platform may lose their Insurance cover as the feud between the Health Maintenance Organisations (HMO) and private health providers under the aegis of the Association of Nigeria Private Medical Practitioners (ANPMP) deepens, Business Hallmark can reveal.

HMOs are the middlemen between the Health Service Providers (HSPs) and the NHIS. NHIS then disburses funds to the HMOs every three months to pay the health service providers monthly for the health services of participants.

It would be recalled that the ANPMP and the HMO had for some time been having a running battle over the refusal of health maintenance organisations to offset the huge back log of debts owed ANPMP members, as well as not sanctioning an upward review of existing tariffs paid to its members.

The disagreement between the two has, however, worsened with the umbrella body of private health practitioners asking all its members across the country to stop rendering services to patients with insurance cover effective February 1 if the HMOs failed to increase their tariffs and renegotiate their service agreements with its members.

According to the National President of ANPMP, Dr. Iyke Odo, private hospitals and clinic are not being paid the going rate for services rendered despite the high cost of goods and services in Nigeria.

“Change in price occurs almost daily. Nigeria has not witnessed price summersault as it has done in the last two years. No cost of medication, medical consumables, medical devices, medical equipment, food items and general cost of living has remained the same.
“Nigerians are adapting and adjusting to spending more for everything else in the environment but hospitals and clinics are rather expected to charge less than they were charging despite the obvious course of inflation”, the ANPMP president explained.

He also blamed the leadership of the NHIS for not living up to its responsibilities of regulating the health insurance sector, thus allowing HMOs to accept extremely ridiculous premiums they know will not pay for the providers’ services, just to secure the business.

“We (health providers) have become burden bearers of the nation’s insurance project as due process, standards and accountability have been negated.

“Health insurance is managed care but the only way its principles can stand is when the conditions necessary to drive a successful health insurance scheme are met and they include appropriate premium pricing, appropriate service tariff pricing amongst others.”

The ANPMP boss lamented that the recommendations made at a joint strategic meeting held in 2020 between the Health and Managed Care Association of Nigeria (HMCAN), Healthcare Providers Association of Nigeria (HCPAN) and ANPMP were never implemented.

According to Odo, a major decision reached at the 2020 summit was the call for the establishment of a national minimum tariff to help stabilize and sanitize the crisis in the private health insurance scheme arising from the price war amongst HMOs.

“HMOs in negotiating premiums for the different insurance plans undercut one another, accept extremely ridiculous premiums they know will not pay for the providers’ services, just to secure the business.

“Such HMOs end up delaying claims payment, some fail to pay, others pay whatever they feel like paying and dare the providers. And yet, others have liquidated with the providers’ claims unpaid.

“This is why today, well over N15 billions of providers claims across the country is trapped with the HMOs under various guises. Following that outing, the HCPAN constituted a joint tariff review committee to actualise the proposed minimum service tariff, and today, here we are.

“The NHIS is not favouring up to 10% of private providers on account of poor enrollment. The state support health insurance schemes have shortchanged you and I across the country.
“Private health insurance has made many of the providers’ mere labour workers, an inch away from slave labour. This is not health insurance. This is exploitation.


“This is an open war on the Nigerian healthcare system and a sure path to the poverty of providers. Much as we desire health insurance, our government should give us health insurance, not make beliefs or look-alikes. If we cannot have health insurance the way it is known to be productive and equitably beneficial, then it should be abolished until we are ready.

“This is a clarion call to all members and to all private providers across the country to use the recommended tariff and renegotiate their services agreements with their HMOs effective 1/2/22. The tariff is the minimum. You can go above it, but you should not come below it,” he advised.

Some doctors who spoke with our correspondent in Lagos lamented the abysmally low fees paid to them by HMOs for services rendered.

The chief medical director of a private clinic in the Agege area of Lagos who did not want his identity revealed, told our correspondent that health providers receive N4,000 from HMOs for treating an enrollee on the NHIS suffering from malaria.

“This is even about the best you can get for the treatment of malaria as some HMOs pay as little as N3,700 despite hospitals shouldering the costs of laboratory tests, drugs and other services.

“Let me shock you further. Fees paid by HMOs for intermediate surgeries like caesarian section which was denominated at N55,000.00 and appendixentomy at N35,000.00 at the commencement of the programme in 2005 still subsist.

“The question is, does this amount reflect today’s economic reality? How do they want providers to survive? We (healthcares providers) are the ones bearing the cost while HMOs smile to the banks”, the CMD declared.

Other doctors also complained of not getting paid in time for services rendered. “Apart from the peanuts being paid to providers, many of us don’t get our dues as at when due.

“It will shock you that some hospitals are still being owed outstanding payments of over four years. Some of them are contemplating instituting court actions to help retrieve their withheld funds”, said another medical practitioner who withdrew his services to the scheme about three years ago.

Meanwhile, BH findings revealed that over 10 millions Nigerians are going to lose their health insurance cover if ANPMP go ahead to carry out its threat.

According The Lancet, a medical journal, about 11 million Nigerians are benefitting from health insurance either through NHIS, state governments or private organisations. However, only 10% (1.1million) Nigerians that enrolled on the NHIS registered with public hospitals, with the remaining (90%) 9.9million getting healthcare services from private healthcare providers.

“What this means is that if the feud between the ANPMP and HMOs is not resolved by January 31, the 10 million Nigerians with health insurance will join the over 190 millions Nigerians who pay out of their pockets for their healthcare whether they can afford it or not.
“This will further put a strain on the already stressed public health sector as civil servants make up the largest percentage of the enrollees on NHIS, with corporate workers in the private sector accounting for a fraction of the number.

“Poorly paid and unable to afford the fees charged by private hospitals as private patients, most civil servants and low-level employees in the private sector will have no option but to switch to public health facilities for their health needs”, declared Dr. Eniola Ogunusi, a retired permanent secretary in the Federal Ministry of Health.

Reacting, the Managing Director/Chief Executive Officer of Avon Healthcare Limited, Adesimbo Ukiri, said the industry should charge appropriate prices for their services.

“There is the issue of the industry undercharging and corporate firms underpricing which is affecting the business.
“There are companies that have been paying the same price for the past five years. Is the cost of healthcare the same in terms of inflation? They should pay what is the fair price,” the Avon Healthcare boss admonished.

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