Considering the global concept of Public-Private Partnership in driving and developing international and national economies, setting up of instruments for the ease of doing business by all nations, which have positively impacted the development of nations, there is need for us to examine the roles of health maintenance organizations in the implementation of the social health insurance scheme in Nigeria.
In Nigeria, health maintenance organizations are the drivers, the watchdogs of service providers and buyers of health insurance for the citizens.
However, health maintenance or management is relatively new to our health care delivery system raising the question as to what exactly the role of HMO’s are and the challenges they face achieving their statutory responsibilities.
In this interview with DAILY POST, the Managing Director and CEO of Ultimate Health Management Services, Mr. Lekan Ewenla gives us an overview of Health Insurance in Nigeria and how his organisation handles the statutory roles and bridges the gap between consumers and healthcare providers.
DAILY POST: Globally health insurance has been said to be the only solution to making health care affordable, accessible and equitable for everyone. So what do you think are the challenges affecting the growth of health insurance in Nigeria in the last 15 years of its existence.
ULTIMATE HEALTH: Health Insurance is the only solution for citizens of all nations to have unhindered access to quality and affordable health care services. The Nigerian government in 2005, passed a law for the introduction of health insurance for the formal sector.
The formal sector is divided into two, the public servants across the federal, state and local government levels and the staff in the organized private sector.
That was the initial focus of the law and it achieved its purpose halfway because the government led through example by enrolling all federal civil servants, alongside their spouses and a maximum of four children under the age of 18 on the health insurance program.
As for the organized private sector, it was neither here nor there. That is why you will see that in the last couple of years when we analyze the percentage of coverage of health insurance in Nigeria, everyone keeps putting the percentage of enrollment between 3 to 5 or 6% of the entire population.
However, we have gone past that because, in the last couple of years, the present administration has put tremendous efforts and deployed innovative strategies and funds to improve Nigeria’s health indices which includes the review of the Bill establishing the programme to make health insurance mandatory for all residents in the country.
As at today, the 9th Assembly has passed the Bill and that law is being gazetted for the endorsement of Mr. President. That is very commendable and that shows commitment and genuine concern for the wellbeing of Nigerians.
DAILY POST: Our constitution is divided into the concurrent and exclusive lists, where does healthcare belong and why?
ULTIMATE HEALTH: Health care belongs to the concurrent category.
What that means is that whatever is done at the federal level is expected to be replicated at the state and local government levels.
That is why you see that there is a national council on health, which comprises all the Commissioners of Health across the 36 states of the federation, including the FCT.
At the local government level, there is the Supervisory Councilor for Health, who deals with the provision of primary health care services at the grassroots level.
Also, there are three levels of care, the primary, anchored at the local government level, while the secondary and tertiary levels are managed at the state and federal levels.
So after the government commenced the health insurance for federal civil servants in 2005, it was expected to be replicated at the state level but unfortunately, most of the state governments did not follow suit, what the federal government now did based on the directive of the United Nations to all member states was that the government of all member nations must ensure the wellness of their people, by earmarking about 2% of their consolidated revenue for healthcare services for the vulnerable in their countries.
This administration must be commended for that compliance because it has completely changed the narration of our health indices and healthcare services in Nigeria.
For the first time in the history of this country, the government has deployed innovative concepts in driving healthcare services, such as government to government collaboration, driving healthcare from the demand and supply perspectives and enhancing the architecture of healthcare services in the country. Now, that has translated into a number of states in the country passing the law to make health insurance mandatory at the state level and what it means is that health insurance is going to be socially driven.
DAILY POST: So we have heard so much about Health Maintenance Organizations, could you shed more light on what the exact roles of HMOs are in facilitating health insurance.
ULTIMATE HEALTH: Globally, the concept of governance has changed from government doing business to government creating the enabling environment for the private sector to drive the economy.
Naturally, the government is expected to create an enabling environment for the organized private sector to drive the economy while it regulates. So that takes us to the proper definition of governance which is a public-private partnership.
This is also why the federal and state government divested their interest in many investments in virtually all business enterprises. For example, the federal government completely divested its interest in NITEL, sold it and created the Nigerian Communications Commission, NCC to regulate the telecoms industry and also gave licenses to the private sector to drive the telecoms business.
Same goes for PENCOM, where the government created the agency to drive pensions and reviewed the law to make it mandatory for all employers of labour to deposit stipends for their employees’ pensions. This same concept was deployed for the health insurance scheme in Nigeria.
The Health Insurance field is meant to be regulated by a federal and state government agency and driven by private investors in the health insurance space, which are called the Health Maintenance Organizations, utilizing the services of all accredited health care providers across the three levels of care.
DAILY POST: Earlier, you mentioned that healthcare is on the concurrent list, how far do you think state governments have gone in deepening the scheme in their domains?
ULTIMATE HEALTH: The truth is that the awareness level and the knowledge about the technical know-how or the fundamental principles of health insurance was not as deep as we all thought across all levels. Even some of the state chief executives did not have a deep understanding of this concept at the beginning but as things unfolded it became clearer that it was a statutory responsibility for them to provide for the medical needs of their employees at the state level and that is being taken care of now.
I think it is also necessary to emphasize that the concept of health insurance was not only targeted at those that are in the formal sector because the bulk of Nigerians are in the informal sector.
By our analysis of the population configuration, about 15% of Nigerians are in the formal sector, the remaining 85% are in the informal sector, so there is a need for these people to be covered by the scheme. In the last 15 years, the clamour has been on the need to extend the scheme to the informal sector.
The states are beginning to understand and they are all keying in and passing the law to ensure that health insurance is taken care of at the state level.
DAILY POST: Can you rate the level of acceptance and uptake of Health Insurance by Nigerians whether at the informal or formal sector.
ULTIMATE HEALTH: As we speak today, the uptake is not that fantastic but the truth is that the awareness level is increasing by the day.
People are becoming more aware of the importance and necessity of having health insurance because the only way people can have unhindered access to quality healthcare is through health insurance. So the awareness level is increasing but the uptake is still very very low.
If I may place a percentage on that, it is still below 10% but it’s improving. It is important to highlight that awareness is increasing and the desire for uptake is also improving and increasing.
DAILY POST. Now, sir, we want to talk about Ultimate Health as an HMO operating in the sector under the regulation of the National Health Insurance Scheme. Tell us, how old is Ultimate Health and what are your unique selling points?
ULTIMATE HEALTH: Ultimate Health HMO was established in 2007 and was accredited by the National Health Insurance Scheme on the 6th of July 2009, 11 years ago. But the Managing Director of Ultimate Health Management Services has been in the Health Insurance industry from 2004 till date.
What has brought us this far is the experience, the deep understanding of the health insurance concept, coupled with the global exposure which we use to garnish the local content to drive the health insurance programs.
In addition to the experience, we have also been driving Ultimate Health strictly with our core values of integrity, professionalism, customer satisfaction and innovation. We drive the business based on set standards by the regulator.
As an organisation, we have decided to walk strictly on the side of the law and that has really helped us a great deal because we understand that, as an HMO, the only thing that can lead us to unprecedented success, is to identify the enrollees’ satisfaction and safety as the major fulcrum of our business.
What translates to our enrollees being treated like kings and queens is the attention we place on the prompt and regular settlements of claims from the service providers.
We are accredited as buyers and sellers of healthcare services. So if you are going to buy and dispense healthcare at a fee, then we ensure that services are paid for as prompt as possible and that has been the secret behind our success as an organization in the industry.
DAILY POST: Is Ultimate Health a National HMO or a regional HMO? Where are your branch offices?
ULTIMATE HEALTH: First of all we are a national HMO. Let me explain this. In 2014, the regulator came up with the concept of categorizing the health maintenance organisations into three as it was done in the banking industry and that brought about three types of HMOs in the country.
We have the state HMO’s, regional or zonal HMO’s and then national HMO’s. So Ultimate Health Management Services from inception till date has been a national HMO. We have our head office in Abuja because strategically, it is right and normal that all national organisations situate the head office of their business where the seat of government is and that is not negotiable.
Our head office annexe, however, is in Lagos and we have offices in all the six geopolitical zones of the country.
DAILY POST: If I were to recommend Ultimate Health Management Services HMO to someone, what would be the Unique Selling Point? What should a client look forward to, what is different in your organisation?
ULTIMATE HEALTH: The difference is the quality of the relationship and management services that we deploy for our critical stakeholders, the promptness of our settlement of claims or bills of providers, provision of quality and satisfactory services and the infrastructure that we put in place for Key Performance Indicator and Total Quality Management.
We do not get off the back of our enrollees and the service providers until we are sure they are smiling. That’s our unique selling points.
DAILY POST: What do you think the federal government can do better in terms of regulating the health insurance sector?
ULTIMATE HEALTH: The federal government must strengthen the regulator and ensure that critical stakeholders play their roles according to the set standards.
I want to also appeal to the government and the NHIS to take a critical look at the quality of accredited healthcare providers and the technical know-how of the accredited HMO’s too.
When the program started in 2005, so many HMOs and health care providers were accredited which was seen to be far more than the volume required based on the number of enrollees and the actual recommended volume for the risk-takers. We don’t need that volume now based on the level of uptake in Nigeria.
So the government should take a critical look at all of that. The regulator should also bring in more medically inclined staff to address some fundamental professional needs at the state, zonal and head offices.