Enrollees with the National Health Insurance Scheme have called for improved services and stress-free services, noting that they go through cumbersome measures to access health care. The enrollees, who are in the FCT, expressed their concerns in separate interviews with the News Agency of Nigeria in Abuja on Sunday, stressing that effort should be put into ensuring that they get value-oriented services from the National Health Insurance Authority
Launched in 2005 as a policy for better healthcare delivery to the public, NHIS was established by Decree 35 of 1999 (now Act 35), operating as a Public Private Partnership to provide accessible, affordable and quality healthcare for Nigerians. The mandate of the scheme, which was reviewed in 2022 and the name changed to NHIA from NHIS, was to attain Universal Health Coverage in Nigeria by the year 2030. The mission is to mobilize and pool financial resources for strategic purchasing of affordable and quality healthcare for all.
NHIA is a social network programme established to provide easy, quality healthcare access to Nigerians at affordable cost. Health Maintenance Organizations were, therefore, appointed as agents to buy healthcare services from public and private healthcare providers; thus, HMOs and NHIS work together, with the HMOs being regulated by the scheme. However, enrollees complained of nonchalant treatment by accredited hospitals. While some enrollees expressed displeasure over long hours before seeing a doctor, others said major health concerns like cancer, heart disease, sickle cell disorder, diabetes or even high blood pressure are not covered. A civil servant and an enrollee, Mrs Ese Williams, said she was referred from the accredited hospital she had been attending to another for further review of her health condition, but it took hours to see a doctor because she was told to provide code for every treatment. Williams said, “The worst part is that when requests are sent to HMOs, they do not respond on time. It takes more than three hours to respond and the sick patient keeps waiting, after leaving his/her house early to access treatment. It is frustrating.” Another civil servant, Ms Julia Steve, who also resides in Abuja, said she abandoned the hospital assigned to her to access medical care under the scheme and has always paid her hospital bill as a private patient. “This is because of poor services and the way some hospitals treat patients under the scheme. “I don’t know why some accredited NHIS hospitals keep complaining that money has not been remitted to them, while drugs are always not available,” she lamented. According to her, she has not used the service for almost eight years due to the nonchalant attitude of the hospital. She, therefore, called on the government to monitor what hospitals and HMOs are doing in terms of providing services to enrollees. “If they are monitored, those not doing well should be delisted,” Steve added.
Another enrollee, Mr Emeka Ojiofor, said that the insurance policy is supposed to alleviate the financial burden of citizens on health. He urged the government to create more awareness about the scheme for enrollees to know the services and ailments covered under the programme and those not covered. He said that the issue of obtaining code from HMOs before a patient is attended to is cumbersome, suggesting that NHIA should deal directly with the hospitals, instead of going through HMOs. The Chief Executive Officer of Ultimate Health, a non-governmental organisation, Dr Lekan Ewenla, said there are optional guidelines to take care of the issue of code, where the primary provider can refer a particular enrollee to access care at the secondary level. He explained that all that is required is a pre-alteration code, which would be expected to be promptly issued by HMOs so that the facility can commence treatment. On the issue of delay, he said that over the years, it had been confirmed that healthcare facilities use codes obtained in January until March, as well as other services. He explained, “Code given for Caesarean Section should not be used for fibroid. HMOs keep getting bills that are not within the approval code. Code given for specific treatment should be restricted to only that treatment. “We have seen a situation whereby a facility will ask for a code to do appendicostomy and they will extend it to other services. And by the time they are sending the bill that is meant for N80,000, you will see a bill of N325,000 coming from the facility.” He said the Director-General of NHIA, Dr Kelechi Ohiri, is reviewing the operational process of the authority to ensure better performance. He added that once the challenges in the health insurance ecosystem are addressed, the regulator should play according to the rules and focus on the right things. He advised enrollees to collect the phone numbers of their health providers and then reach out to the HMOs, warning “Any HMO that is not reachable should be queried. “On the issue of inferior drugs, the scheme introduced the prescription of generic medications, which people assume are inferior drugs, but they are also as good as the branded ones. “NHIA has initiated a process of branding medications that would be utilised on the health insurance programmes. You will see the package as NHIA medications and it will eliminate the perception of generic medications.”
