AMIDST the complaints by the National Health Insurance Scheme (NHIS) enrollees, University College Hospital’s Chief Medical Director, Professor Jesse Otegbayo says the national health insurance remains the best option to ensure access to basic health care services in Nigeria.
Professor Otegbayo, who spoke at a training to strengthen the hospital’s NHIS services on Tuesday, stated that if NHIS is well applied, everyone will benefit from it in that it is structured to cut out of pocket spending on health and ensure access to health care services.
Otegbayo, presented by the Director of Hospital Serices, Dr Abiodun Adeoye stated, “NHIS is the best that can happen to any nation when it is well applied. Everyone will benefit from it, both the enrollee and the service provider. The structure is meant to make sure that people are happy and they have access to basic health services.
“But if it is not well managed, one of our labour leaders termed NHIS a curse. When it is well managed is never a curse; it is a blessing. The training is so that we can know more about NHIS.”
Head, Standard and Quality Assurance Department, NHIS Oyo State, Dr Idowu Odekunle in an overview of NHIS operational guidelines, said if any nation will achieve universal health coverage, NHIS cannot be overemphasized.
Dr Odekunle stated that the scheme’s operational guideline determines healthcare services available under the scheme and due process has to be followed if the scheme will work to ensure access.
According to her, enrollees on the scheme often are in a hurry, forgetting that every enrollee must be registered to have been seen and follow due process.
Dr Odekunle said that health providers and health management organizations that contravene the NHIS operational guidelines are penalized, including health care providers paying a penalty ranging from N100, 000 to N500,000, and even delisted from the scheme.
Coordinator, Management Care and Healthcare Consultants, Mr Iloani Chukwunonso stated that complaints on nonpayment of claims and bill variance under the scheme arise from clinical issues such as requests for approvals for HMOs’s not properly detailed, prescription and investigations that do not tally with patients’ diagnosis and prescription of expensive branded drugs.
Managed United Healthcare, the hospital’s HMO, representative, Dr Ayodeji Dada stated that the quality of the hospital’s NHIS services can be assured when it ensures patient’s safety, saves money and time, meets patient’s demands, provide stable and competitive products as well as maintain the reputation of the hospital.
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