Health insurance enrollees seek improved services, decry cumbersome process

Some registered in the National Health Insurance Plan of the Federal Capital Territory have asked for improved services and less stress, saying that they go through cumbersome measures whenever they want to access health services.

Those enrolled in the scheme, now the National Health Insurance Authority, raised their concerns during separate interviews in Abuja on Sunday.

Launched in 2005 as a policy for better delivery of health care to the public, NHIS was established by Decree 35 of 1999 (now Act 35), which operates as a public private partnership to provide accessible, affordable and quality to Nigerians.

The mandate of the scheme, which was revised in 2022 and renamed NHIA from NHIS, is to achieve universal health coverage in Nigeria by 2030.

The mission is to mobilize and pool financial resources for the strategic purchase of affordable, quality health care for all.

NHIA is a social media program established to provide easy and quality access to healthcare to Nigerians at an affordable price.

Therefore, Health Maintenance Organizations were designated as agents to purchase health services from public and private health providers; thus, HMOs and the NHIS work together, and HMOs are regulated by the scheme.

However, the subscribers/enrollees complained of indifferent treatment by the accredited hospitals.

While some enrollees expressed discomfort with long hours before seeing a doctor, others said major health issues such as cancer, heart disease, sickle cell disease, diabetes or even high blood pressure.

An official and an enrollee, Ese Williams, said she was referred from the accredited hospital she had been attending for a more detailed review of her health status to another hospital, but it took hours to see a doctor because I had to provide the code for each treatment.

Mrs Williams said: The worst thing is that when applications are sent to HMOs, they don’t respond in time. It takes more than three hours to respond and the sick patient is still waiting, after leaving home early to access treatment. It’s frustrating.

Another enlisted official, Julia Steve, who also lives in Abuja, said she left the hospital assigned to her to access medical care under the scheme and always pay her hospital bill as a patient private because of poor services and the way some hospitals treat patients under the scheme. outline

He added: I don’t know why some NHIS accredited hospitals continue to complain that money is not remitted to them, while medicines are not always available.

According to her, she has not used the service for almost eight years because of the indifferent attitude of the hospital.

He therefore called on the government to monitor what hospitals and HMOs are doing in terms of services to enrollees.

If they are monitored, those who do not do well should be removed from the list, Ms Steve said.

Another registrant also a resident of Abuja, Emeka Ojiofor, said the insurance policy was to ease citizens’ financial burden on health.

Ojiofor urged the government to create more awareness about the scheme so that enrollees are aware of the services and diseases covered by the scheme and those not covered so that patients are aware of them.

He said the issue of getting codes from HMOs before treating a patient is cumbersome, suggesting NHIA should deal directly with hospitals, rather than going through HMOs.

The executive director of Ultimate Health, an NGO, Dr. Lekan Ewenla, said there were optional guidelines to address the code issue, where the primary provider can refer a certain enrollee to access care at the secondary level.

He explained that only a pre-alteration code is required.

Ewenla said the code is expected to be issued quickly by HMOs so the facility can begin treatment.

On the subject of the backlog, he assured that over the years it has been confirmed that health centers use codes obtained in January until March, as well as other services.

He explained that the code given for C-section should not be used for fibroids. HMOs continue to receive bills that are not within the approval code. The code given for a specific treatment must be restricted to that treatment only.

We have seen a situation where a center will ask for a code to do an appendicostomy and extend it to other services. And when they send the invoice for N80,000, you will see an invoice for N325,000 from the facility.

He said the Director General of the NHIA, Dr. Kelechi Ohiri, was reviewing the operational process of the authority to ensure better performance.

He added that once the challenges in the health insurance ecosystem are addressed, the regulator should play by the rules and focus on the right things.

He advised enrollees to collect the phone numbers of their health care providers and then contact HMOs, adding that any HMOs that are not accessible should be consulted. On the issue of inferior drugs, the scheme introduced the prescription of generic drugs that people assume are inferior drugs, but are just as good as brand name drugs.

NHIA has started a process of branding drugs that would be used in health insurance schemes. You will see the package as NHIA drugs and remove the perception of generic drugs.

(NAN)