To remain relevant and reputable in the new National Health Insurance Scheme (NHIS), the Federal Government on Thursday warned the operators of Health Management Organizations (HMOs) against their usual poor service delivery.
It further warned that they should not allow their economic interests to submerge their patriotic obligations, “in our collective effort to build a nation of healthy and prosperous people.”
Speaking at the Strategic Stakeholders Engagement for Health Maintenance Organizations (HMOs), in Abuja, the Minister of Health, Dr Osagie Ehanire, told the HMOs to review their operations and business processes.
The minister pointed out that other stakeholders, especially the enrollees and the Health Care Providers (hospitals) have all expressed concern over the poor performance of the HMOs, over non-remittance of payments to healthcare providers, poor customer service delivery and inaccessibility to enrolees at critical moments of need.
Dr Ehanire, who was represented by the Director, Hospital Services in the ministry, Dr Omale Joseph, warned that these anomalies would no longer be accepted, because the government is determined to get it right with NHIS.
The minister said: “I wish to repeat myself by saying that all stakeholders of the National Health Insurance Scheme are expected to take advantage of the reform mood of the regulatory body, to critically examine themselves and their operations.
This is the only way to remain relevant and reputable in the new NHIS we are building.
“Particularly, let me at this juncture call on all of you, operators of the Health Maintenance Organisations (HMOs), to use this opportunity to review your operations and business processes.
“Reports reaching me indicate that an overwhelming percentage of enrollees and health care providers have expressed grave concerns over the performance of HMOs, with areas of the concerns including, but not limited to, non-remittance of payments to healthcare providers, poor customer service delivery and inaccessibility to enrolees at critical moments of need.
“The collective results of these and many other cases of service failure in the industry are poor service delivery, poor quality of care and worrisome reputation damage for the Scheme.
“Let it be noted today, ladies and gentlemen, that these anomalies are no longer acceptable, because this government is determined to get it right with NHIS, in view of its status as a strategic tool for effective and efficient healthcare delivery system in the country.
“I, therefore, have no doubts that the HMOs will key into the reforms to rebrand NHIS, by frankly addressing internal reforms within and among themselves.
“At this juncture, I give credit to the Management of NHIS, for creating this serial platforms of consultations with all the stakeholders, with a view to engendering seamless interactivity, thereby bringing every player in line with operational standards of procedures, leading to improved service delivery, which will in turn restore public confidence in the Scheme.”
He added, “we must ensure always in our dealings, that our economic interests do not submerge our patriotic obligations, in our collective effort to build a nation of healthy and prosperous people.”
The Executive Secretary of NHIS, Prof. Mohammed Sambo, gave the three points agenda of the newly reformed NHIS; which is aimed at restoring a value system that will transform the scheme into a credible result-driven organization; engendering transparency and accountability in it entire operation; and accelerating the drive towards achieving universal access to quality healthcare for all Nigerians.
Prof. Sambo listed the complaints by enrollees as delay in issuance of authorization codes; none response of calls by HMOs, delay in payment to Health Care Facilities (HCF- hospitals), and lack of holding adequate sensitization forum between the HMOs and HCF.
Also from the health care providers’ perspective, the Executive Secretary listed their complaints as delay in issuance of authorization codes, delay in settlement of claims, payments without pay advice, inexplicable vetting of claims, outright rejection of bills, no standard billing template and payment to wrong TSA accounts.
However, he said: “We at NHIS are working assiduously to rebrand the scheme as the foremost result oriented organization in the health insurance industry in order to achieve our mandate of Universal Health Coverage (UHC).
“We are also very optimistic that with your support, this objective will be realized for the benefit of all Nigerians.”