By Bassey Udo
To avoid service disruption to subscribers, the National Health Insurance Scheme (NHIS) on Monday waded into the lingering dispute between Health Care Providers (HCPs) and Health Maintenance Organisations (HMOs) in the country.
The intervention in the crisis by the NHIS was pursuant to its mandate as the regulatory authority in the health insurance practice in Nigeria.
At the end of a meeting between the two groups convened by the Executive Secretary of the NHIS, Mohammed Sambo, an interim understanding aimed at averting a potential crisis was reached, to ensure that persons operating health insurance on a private basis were not stranded.
Private health insurance is a practice where HMOs buy health care for interested persons under predetermined arrangements outside the NHIS system.
Following the lingering dispute, hospitals under the aegis of Health Care Providers Association of Nigeria (HCPAN) and other associate bodies announced plans to drop Health Maintenance Organisations (HMOs) and impose a new tariff structure for private health insurance subscribers from February 1, 2022.
The announcement created huge anxiety within the health insurance ecosystem in the country.
Addressing representatives of the two disputing groups during the meeting, Sambo identified the NHIS as the only legally recognized body in the country authorised to come up with services tariffs for health insurance.
He said that the primary objectives of social health insurance was to limit the rising cost of healthcare services, to protect subscribers from financial hardships as a result of unaffordable medical bills.
Sambo, however, expressed reservations that the system had tolerated for too long HMOs who run “Private Health Insurance” which brought distortions to social health insurance implementation in the country.
He said he was optimistic that the expected passage of the NHIS bill to make health insurance mandatory would permanently resolve all such distortions.
“Social health insurance is the only vehicle by which every Nigerian can access quality and affordable healthcare. Therefore, any element that will threaten the smooth operation of social health insurance scheme in Nigeria must be eliminated by all means”, Sambo said.
The Executive Secretary noted that taking the issue to the public space in the manner the stakeholders did left much to be desired, adding that disagreements could be resolved when parties listen to each other’s positions and make effort to reach a compromise.
Speaking on behalf of Health Care Providers, Jimmy Arigbabuwo, said HMOs foisted their own tariffs on providers without regard to inflationary realities, insisting that HMCAN did not act in good faith, even as they provided services to their clients.
On their part, the spokesperson for HMCAN, Leke Oshuniyi, said members of the association were open to negotiations with the view to bringing the dispute to a close.
At the end of the meeting, representatives of Health and Managed Care Association of Nigeria (HMCAN), Health Care Providers Association of Nigeria (HCPAN), Guild of Medical Directors, AGPMPN and other stakeholders agreed to propositions by the Executive Secretary of NHIS on the way forward.
The propositions included an agreement by parties for reconciliation exercise to be conducted by NHIS to ascertain the level of indebtedness by HMOs to the providers, to be preceded by a media advertorial.
Also, a rapid assessment of HMOs’ private plans to be conducted to ascertain their level of conformity with the NHIS prescribed arrangements.
Besides, HCPAN would immediately withdraw its announced tariffs, while other stakeholders who had their own tariffs would do the same.
In addition, HCPAN and HMCAN were given two weeks to negotiate and agree on a mutually accepted tariffs structure, while a follow-up meeting was scheduled for February 7, 2022 to evaluate progress.
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