NHIS: Reps’ probe opens can of worms
The House of Representatives’ Committee on Health Services, last week, conducted an investigation into the compliance rate of Health Maintenance Organisations (HMOs) to the National Health Insurance Scheme (NHIS) contributions and utilisation of funds by the health care providers. PHILIP NYAM reports that the exercise witnessed chilling revelations on the corruption in the programme
The National Health Insurance Scheme (NHIS) was conceived to make health care accessible to Nigerians, particularly those who cannot afford medical care in expensive private hospitals. But less than 20 years into the scheme, it has become clear that some unscrupulous individuals have decided to convert the programme into an avenue to make money at the expense of lives of many hapless Nigerians.
Before the House of Representatives mandated its committee on health care services to probe into the activities of the Health Maintenance Organisations (HMOs), it has received over 450 petitions on the failure of the HMOs. According to the chairman of the committee, Hon. Chike Okafor, who lamented that the scheme was on the threshold of favour as it services only a few, the petitions are still counting. Of course, the rot in the scheme was exposed at the two-day investigative hearing as stakeholders engaged one another in open exchange of words with counter allegations and sordid discoveries.
The Minister of Health, Prof. Isaac Adewale, opened the floodgate of allegations in his remarks at the occasion, when he declared that despite the N351billion received by Health Maintenance Organisations (HMOs) from Federal Government since inception for the expansion of the National Health Insurance Scheme (NHIS) has not been judiciously utilised.
The minister who was represented by the Director, hospital services, Federal Ministry of Health, Dr. Wapanda Balami, said the amount ought to be for the expansion of the scheme but the reverse seems to be the case. “N351billion is what HMOs received. This payment ought to be for the expansion of the HMOs scheme but the reverse seems to be the case,” he stated.
He said 70 per cent of the fund is expected to be transferred to health care providers but that has not been done accusing HMOs of diverting the premium. The minister therefore charged the House committee on health to sanction the erring HMOs.
The Executive Secretary of NHIS, Prof. Usman Yusuf, was most opened and aggressive in his disclosure of the corruption being perpetrated by the HMOs. He decried the activities of HMOs, which he likened to the fraud in the fuel subsidy scheme, stressing that other countries are succeeding without HMOs and Nigeria should not be exceptional. According to him, the HMOs are usually paid three months in advance, but lamented that “the HMOs have only increased the number of enrollees, padding figures so that they can get paid.”
He added that none of the 57 HMOs has a valid license saying most of their accreditation has expired. “If by July they don’t renew their accreditation, they will be delisted. Biometric will be introduced in the NHIS register in order to reduce fraud in the healthcare sector. NHIS will fight for the enrollees and recoup the N351 billion debt. When HMO is blocked more money will come,” he said.
The visibly angry Yusuf had vowed to ensure that any HMO owing health providers, would not be re-accredited. According to him, a total of N60 billion has been paid to HMOs without commensurate results.
He also told the lawmakers that he has changed the quarterly payment to a monthly payment as a way of ensuring that HMOs pay service providers. “HMOs did nothing but are blood suck-ing merchants,” he had said.
Yusuf added that the HMOs owe hospitals over N2.6 billion. The HMOs, he said, are the “big mistakes” the country has made, “and we’re going to fix.”
He said there is corruption in the scheme adding that NHIS ICT department was used by HMOs to pad up to 23,000 enrollees. “Straight from our office, we will pay hospitals. And that is what we will do and save Nigeria’s money.”
As regards complaints that he is no longer three months advance is was the tradition, “The last time you receded three months ahead, what did you do with it,” he had retorted.
Yusuf also called for the need to strengthen the NHIS act. While assuring accountability and transparency, Prof. Yusuf disclosed that NHIS enrollees will soon be deployed to HMO offices.
Participants at the two-day investigative hearing were most incensed when Speaker Yakubu Dogara disclosed that over 67 per cent of Nigerians amounting to over 100 million poor families, cannot afford to pay hospital bills for treatment of illnesses such as malaria in public health facilities. While declaring the event opened, Dogara, said if Nigeria must achieve its national health objective of providing health for all, a situation where poor and vulnerable families in Nigeria do not have access to basic health services must be addressed by extending the coverage of national health insurance to them.
He said: “Regrettably, there is no mechanism to protect vulnerable families from the catastrophic effects of the exorbitant cost of healthcare services in Nigeria. Poor families, who constitute over 67 per cent of our population, (well in excess of 100 million Nigerians), cannot afford to pay hospital bills even for treatment of malaria in public health facilities, nor for routine ante-natal services.
“If we must achieve desired outcomes and changes, there is a compelling need to expand the coverage levels of NHIS, currently estimated to be about four to five per cent of Nigerians, mostly in the formal sector.
“A scenario where even this abysmally low coverage is attributable to those in paid employment and other types of formal sector creates suspicion of lack of creativity and innovation on the part of key actors in the Health insurance industry in Nigeria, especially HMOs.”
He noted that the importance of the National Health Insurance Scheme (NHIS), which was established in 1999 with the overall purpose of securing universal coverage and access to adequate and affordable health care in order to improve the health status of all Nigerians.
According to him, no nation can achieve a healthy milestone in the health sector without having such a health finance scheme mandated to check health emergency, reduce out-of-pocket spending for health services and avert what would otherwise be a national health crisis.
Speaking further, Dogara noted that selection of adequate and efficient methods of financing, in addition to organisational delivery structure for health services, is essential if a country is to achieve its national health objective of providing health for all and the way a country finances its health care system is a key determinant of the health of its citizenry.
“Health care in Nigeria is financed by tax revenue, out-of-pocket payments, donor funding, and health insurance (social and community),” he said, while calling on relevant stakeholders to make contributions towards achieving the goal of the National Assembly to address the challenges, and proffer ideas towards resolving areas of concern so that drastic changes can be made for a better healthcare delivery system in Nigeria.
In spite of the obvious infringements by the HMOs, the committee cautioned the Executive Secretary of NHIS, Prof. Yusuf Usman to follow due process in his bid to re- accredits the HMOs.
Chairman of the committee, Hon. Chike Okafor said any actions of the NHIS boss must align with the Act setting up the organisation lest he would be going against an act of parliament. He asked: “NHIS is to pay three months in advance and you’re paying one month….,” nothing that no matter how passionate the NHIS boss feels about the issue, due process must be followed.
“If the law says you must pay through HMOs that’s what you have to do, until the relevant section of the law is amended, that is the truth. We are lawmakers not lawbreakers. We have to ensure that the right thing is done,” Okafor said.
The chairman said there is a need for all stakeholders to collaborate in a bid to ensure good health delivery system for Nigerians. “There was a system that we had in place and it was working for some people and that system was what Prof met. But the ultimate beneficiaries of the systems, is that the ordinary Nigerians were not benefiting from the system. That is what brought us to where we are. And going forward, both the service providers, the NHIS, HMOs and lawmakers, must work together to make sure the system works.”
As the House resumes next Tuesday from its Sallah break, the committee is expected to turn in its report and recommendation for further legislative actions. The report of the committee cannot certainly be different from the discoveries, concerns and views expressed by key stakeholders in the NHIS. Some drastic actions need to be taken immediately since health is wealth and government should not allow a few individuals or groups toy with the lives of millions of her citizens.