Health is Wealth. So goes a popular saying and therefore in every country, the health sector is critical to social and economic development with ample evidence linking productivity to quality of health care. In Nigeria, the vision of becoming one of the leading 20 economies of the world by the year 2020 is closely tied to the development of its human capital through the health sector.
Given this lofty dream, the nation’s quest for rapid economic development could be a mirage unless federal government intervenes in the current operations of the National Health Insurance Scheme (NHIS), charged with the responsibility of providing easy access to health care to all Nigerians.
This is so because the 11 year old scheme which is to provide health care at affordable prices to Nigerians, who, will in turn contribute to the nation’s Gross Domestic Product (GDP) are being denied under the pretext that the current 15 percent deductions from workers salaries is not enough to avail them of the necessary health care services.
The Scheme, which was established under Act 35 of 1999 by the Federal Government of Nigeria, is aimed at providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.
Under the scheme, employers contribute 10 percent while employees make it up with the 5 percent monthly. Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals.
GDP is the total market value of all final goods and services produced by labour in a country within a given year. It can be estimated, in theory, on expenditure basis, which is how much money was spent, output, how many goods and services were sold and Income basis, how much income (profit) was earned within that period.
Being as it may, economists use GDP indices to measure the overall growth or decline of a nation's economy among others.
Although most of the stakeholders who spoke with Business Day agreed that capitation, which is the monthly payment of between N500 and N550 per head by Health Management Organizations (HMOs) to primary health care providers (Hospitals) is too meager, they deplored activities of the two parties which embark on delay tactics, thereby frustrating the patients. The essence is to maximize gains from the contributions as 62 percent of the capitation is expected to be expended on the patients.
The hospitals make recourse to HMOs on complicated ailments or those that require attention of specialists for authorization before proceeding to treat the patients. In most cases, the HMOs would foot drag in sending the needed code that will enable the hospital access to funds on treating the patients. Hospitals, on the other hand, resort to dispensing low quality drugs to patients. At the end of the day, patients are forced to seek for alternative services, while the capitation, which is usually paid in advance, will not be used for the purpose for which it was released.
Adeyeye Arigbabuwo, General Secretary, Healthcare Providers Association of Nigeria (HCPAN), who spoke exclusively to BusinessDay disclosed that the 62 percent of the capitation meant per head for enrollees to receive healthcare services under the scheme has led to the low quality of services and drugs administered to Nigerians
who may not be commensurate to improve the health of the patient.
According to Arigbabuwo, capitation is used for providing primary healthcare services only hence it is also used to control use of health resources by putting the physician at financial risk for services provided to the patient. He hinted that providers are paid according to the number of enrollees attached to the family.
In his words “Don’t forget that the actual amount of money paid (capitation) is determined by the range of services provided, the number of patients involved, the period of time during which the services are provided. All these are developed using local cost and average utilisation of services. Aside this, the HMO makes the fee for service payment to non-capitation receiving healthcare providers who offer services on referral from other approved providers.
Arigbabuwo maintained that why hospitals make recourse to HMOs for authorization before embarking on higher/expensive treatment is that the level of care has gone beyond the primary care level and as such codes or pre-authorization are needed to be given by the HMO to the secondary care provider to treat the patient.
He added “though the authorization is to prevent abuses as well as ensure that appropriate healthcare provider provides the relevant healthcare services which is commensurate to the patient’s need, more often than not, providers take undue advantage of the low tariff to foot drag on issues of carrying out treatment which sometimes lead to the death of such patients.
You will recall that in the United States of America, about 90 percent of the health budget of 2010 was passed to the general practitioners to decide what the primary, secondary or tertiary healthcare provider receives for services rendered enrollees of the health insurance scheme, adding “such a feat can be replicated in Nigeria.”
For Victor Amadi, Lagos State Coordinator, NHIS, drugs that are administered to enrollees at the hospitals are the prescribed drugs, pharmaceutical care and diagnostic tests contained in the National Essential Drugs List and Diagnostic Test Lists. He noted that if the drugs are not covered with the scheme, the enrollees through its healthcare provider are given the drug list which he should purchase elsewhere.
Amadi disclosed that at the moment, a 48 hour range is given for response by HMO to carry on with the treatment as if such doesn’t happen, the other provider can carry on with the treatment pending when the HMO respond.
There is no gain saying that with life expectancy in Nigeria at approximately 47 percent as against World Health Organization’s (WHO) life expectancy average at 67.2 percent, providing quality healthcare services to Nigeria will not in any way portend danger for the economy.
Critical interventions recommended to revamp the healthcare system in the country include increasing government allocation to health at all levels, expanding the NHIS coverage and regulatory functions, implementation of the community-based health insurance schemes, as well as pooling funds using common basket approaches by all actors involved in financing health in Nigeria.
Alexander Chiejina
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