NHIS: NMA directs doctors to shun state health insurance schemes

The Nigerian Medical Association (NMA) has directed all doctors not to participate in any State Health Insurance Scheme (SHIS) until there is ”meaningful engagement” between the government and stakeholders.

This was part of resolutions at the end of NMA’s National Executive Council (NEC) meeting held on Sunday in Uyo, Akwa Ibom state capital. There, the association noted that many states had started activating their health insurance without the input of the body of doctors.

It directed members not to partake in the scheme until “there is meaningful engagement between the government and stakeholders on workable, beneficial and sustainable terms and conditions acceptable to all parties”.

Copies of a communique containing observations and resolutions adopted after the meeting were made available to journalists on Tuesday shortly after a briefing by NMA President, Francis Faduyile, in Abuja.

The doctors observed that the manner some state governments are going about the establishment of SHIS lacks the necessary determinants for success. Many states have begun implementation of the SHIS.

Vanguard in 2016 reported the signing into law, a bill for the establishment of the scheme by seven states as mandated by act guiding the National Health Insurance Scheme (NHIS).

They are: Lagos, Delta, Bauchi, Kaduna, Sokoto, Abia and Anambra. States such as Kwara, Kano and Imo earlier this year flagged off their respective SHIS.

But as it is with NHIS, currently dogged with multiple challenges 13 years after inception, experts believe health insurance in states will not also work if proper implementation plan is not put in place.

This among others have led to calls for a repeal of the NHIS Act and the enactment of a new Act. With a new act, practitioners in the health sector believe how the SHIS should function will be clearly stated.

“What we are seeing is that some of the state governments have started politicising the SHIS. They have joined hands in some programmes that will not make the scheme work effectively,” Mr Faduyile said. ”Some of them are playing to the gallery…”

“State insurance scheme is actually meant to help reduce costs for both patients and the primary providers. For instance, while decapitation for NHIS is N750 and we are complaining, what some states are pushing forward is less than N500 and it cannot take care of ordinary treatment for common diseases,” he said.

He said, if the association goes ahead with the current plan, there is no way Nigerians can have an effective health insurance scheme in the states.

He said that is why the association gave the directive in line with the MDCN (Medical and Dental Council of Nigeria) that every state must be able to seek the consent of the board of doctors which are majorly the primary providers.

“We cannot say we are doing insurance scheme for doing sake, it must be done efficiently. Our leaders are in the habit of building big beautiful hospitals with no staff, drugs and equipment,” he said. ”We don’t want the same situation in the health insurance. We are asking for a sit-down that will bring the necessary acceptance that all parties involved will be happy with once and for all.”

The NMA president, however, did not clarify how the doctors will “not participate” in the scheme if their demands are not met.

“The NEC called on the concerned state branches of NMA and its affiliates especially the AGPMPN to engage the state governments to work out what is acceptable to all parties,” resolution 11 on the communique read.

NHIS deals with two major components: Health Maintenance Organisations, (HMOs) and Health Service Providers, (HSPs).

The NHIS disburses to the HMOs every three months who now pay the health service providers monthly for health services of participants.

Many health service providers, mainly doctors have repeatedly complained of getting low funds from the HMOs, consequently making them unable to meet up with enrollee’s health package demands.

Since its inception, the HMOs have operated freely without probe and have been paid N351 billion by the federal government.

Also, the administrative fee paid to them for the period of 13 years is N60 billion.

Parliamentary Scrutiny

Calls for investigation into the activities of the scheme prompted a public hearing at the floor of the House of Representatives last June on how the N351 billion was spent.

The embattled Executive Secretary of the scheme, Usman Yusuf, at the hearing blamed the HMOs for the failure of the NHIS to deliver on its mandate.

He likened the alleged corruption by the HMOs to the fraud in the fuel subsidy scheme. He also said enrollee figures were being padded.

The HMOs have refuted the allegations. They blame the several breaches in the implementation of the scheme on improper coordination and structural defects in the NHIS management.

Source: Premium Times.

Leave a Reply

Your email address will not be published. Required fields are marked *