"How the NHIA law is redefining the roles of HMOs and health insurance coverage" - Daily Trust

“How the NHIA law is redefining the roles of HMOs and health insurance coverage” – Daily Trust

Professor Mohammed Sambo is the Chief Executive of the National Health Insurance Authority (NHIA). In this interview, he talks about the rebranding program of the organization, the expansion of health insurance coverage for Nigerians, and the operationalization of the NHIA Act, among others.

OWhat is the current level of health insurance coverage for Nigerians?

Current health insurance coverage to date is around 16 million people, so it still hovers below 10%.

The National Health Insurance Scheme (NHIS) was originally designed to provide health insurance to people in the public sector. What has been done to broaden the scope?

Much has been done to ensure everyone is on board the National Health Insurance Scheme (NHIS) now known as the National Health Insurance Authority (NHIA).

You are aware of the crisis that plagued the organization for years into 2019, and of the Presidential Commission of Inquiry that led to bold steps being taken to reorganize the organization; which came as a product of this presidential panel report.

When we got on board, we had an x-ray of the ecosystem and realized there were so many problems. Besides the x-ray of the situation, the report of the presidential panel revealed many problems and about ten key problem areas were defined to be quickly solved.

So our first year was dedicated to ensuring that we brought stability to the organization. We then embarked on what we call the organization’s rebranding program, which was anchored on three pillars.

First, restore a value system that will make the organization credible and results-oriented; second, how to engender transparency and accountability throughout the functioning of the organization; and third, how to accelerate progress towards the achievement of universal health coverage (UHC).

We felt that rebranding efforts are very important to be able to stabilize the organization; second, to reform the organization and third, to refocus the organization for better performance.

And we went straight to deconstructing the pillars into various elements. If you look at the first pillar, it has about three elements that have to do with creating a very good enabling environment, ensuring discipline within the organization and creating mutual respect and harmony, and ensuring that that equity be engendered in the management process of the organization.

And we stepped in to implement all of the elements that we identified as essential to stabilizing the organization.

This is why this organization which was notorious in terms of crisis has now completely transformed; you no longer hear any crisis inside or outside the organization.

What are you doing to ensure transparency and accountability in the health insurance ecosystem?

We have worked closely with all players in the health insurance ecosystem and have been constantly engaged in the process of informing, educating and enlightening people so that they know what is health insurance, what are their roles and responsibilities.

We also recognized the fact that to have an overall transparency system, we have to digitize the system so that everything that is done in the organization, in the whole ecosystem, can be driven digitally.

As the general manager, you can be here and monitor everything that is happening in terms of service delivery, finances, etc. so we did all of that.

Can you briefly tell us how you are expanding the fiscal space?

We pursued it in a two-pronged approach that is in line with the third pillar of rebranding. First, we have tried to consolidate the existing programs there; programs for formal sector employees and non-formal sector employees.

There were a lot of bottlenecks in the implementation of these programs, so we tried to look at those bottlenecks with a view to figuring out how to solve them, and we went far trying to solve most of the key critical issues that affect the proper functioning of this system.

Then, the second concerns innovation. We have created many innovations aimed at expanding fiscal space.

One of the things that we have done, although we have encountered it on the ground but have not implemented it, is the issue of the Basic Health Care Provision Fund (BHCPF); it is a creation of the National Health Act.

It comes from one percent of the treasury, and about 50 percent comes to NHIA, and we in turn distribute it to the states because the states have their state health insurance agencies, so they can cover the vulnerable segment of the population. By vulnerable we mean the poor, women of childbearing age and children under five, people with disabilities and other disadvantaged people.

This is what the BHCPF aims to achieve and if you go to almost every state apart from Rivers and Akwa Ibom, you will realize that a lot of vulnerable people are already benefiting from the program.

Second, we have also created what we call the Collective Social, Individual and Family Health Insurance Scheme (GIFSHIP). About a year and a half ago, the Minister of Health launched the program and it is intended to attract the informal sector.

If you look at the segment of the population in the informal sector, I mean the self-employed, people working in organizations that have less than five workers, they constitute the majority, the bulk of the population.

Prior to our arrival, there was no significant provision to bring health insurance to this group of Nigerians. But with the GIFSHIP, people can now, regardless of their professional status, be it an individual, a family or a group bound by one form of cohesion or another, enter the National Health Insurance System.

But the most important thing we’ve done in expanding the physical space is making sure we’ve changed the law establishing the National Health Insurance Scheme (NHIS) to what you now have as National Health Insurance Authority (NHIA).

So how did you operationalize the NHIA Act?

The most important aspect of this Act is that it provides for what we call the Vulnerable Group Fund (VGF), and the fund is intended to support approximately 83 million poor Nigerians who do not have financial access to the system. health care.

With the signing of this law, health insurance is now compulsory. So, regardless of where you are and your ability to pay, you must enter the national health insurance system.

If you are not so gainfully employed that you cannot pay for health care or health insurance services, you have the option of being covered through this fund for vulnerable groups.

And for us to achieve that, we need to develop an operational guideline. We also need to have a very solid conversation on the issue of innovative financing that can bring a lot of resources into the health system, and we are already working on that.

What is the role of health maintenance organizations (HMOs) under the new law?

There is a social health insurance which is a solidarity device that aims mainly to meet the needs of those who do not have access to health care, and this is what the public health insurance system aims to promote.

On the second part, there is private health insurance. Private health insurance is an insurance system that people who have financial access can go for.

So what the new law says is that we should have a very clear demarcation between the two. You drive social health insurance with little or no HMO involvement. Then you have private health insurance that HMOs will drive.

As we begin to implement this law as a package, you will realize that a lot of things are going to change with regard to the operation because health insurance intends to provide what is called the minimum health care package – a package that every Nigerian should have access to regardless of socio-economic status.

And under this new law, this will be driven solely by the National Health Insurance Authority and state health insurance agencies. Thus, these very recurring bottlenecks at the level of the interface with the HMOs will no longer exist.

However, HMOs will be allowed to do other things. First, HMOs will pilot what is called supplemental health insurance, any insurance beyond the minimum care package can be piloted by them.

HMOs can also conduct what is called private health insurance, as I explained.

Then, in the law, there is a provision for what is called third-party administration (TPS), and HMOs can act as third-party administration. Third-party administrations are organizations with a private vocation that can come to work with health insurance at the national or state level to be able to take charge of certain aspects.

For example, a state wishes to set up a call center system allowing a registrant to request an investigation or file a complaint. The state can say we don’t have appellate jurisdiction or we don’t have a structure to do so, then the third party admin can help the state or on any other issues like the financial management system , etc.

So the rumor going around that we’re trying to dump HMOs isn’t quite true. We are redefining their functions for the benefit of all in Nigeria.

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