The Health Management Organizations (HMOs) are very powerful,rich and well connected.They are the new mafias,though they hate being likened to the oil subsidy cartel,that held Nigeria hostage for years – getting paid for premium motor spirit they never imported.The Health Management Organizations are right to a certain degree,as their health “enrollees scam” has no foreign exchange component. It is naira denominated,unlike that of the oil subsidy cartel,which was in dollars. But N350 billion is a huge sum.It is the combined Budget of three states. For 2017 fiscal year Kaduna State budgeted N215.9 billion,while Nasarawa State budgeted N68 billion.This is the amount that less than 80 HMOs have “corned” for themselves.
Professor Usman Yusuf,the Executive Secretary of the National Health Insurance Scheme(NHIS),appointed last year by President Buhari ,has dared to be different and this is why for the first time,the monumental fraud being perpetuated by the HMOs is making news.”I said before and I will say it again,that the HMOs as they operate in Nigeria are a huge fraud. We are paying the HMOs three months in advance on behalf of the enrollees,to pay the hospitals. But they don’t”. Damning statement.Though the HMOs have denied the allegation and threatened court action,none has been forth coming,an indication that there is fire,behind the smoke.
Who are the HMO”s and their functions?Health Maintenance Organization (HMO) are private or public incorporated company registered by the Scheme solely to manage the provision of health care services through Health Care Facilities accredited by the Scheme. The law establishing the scheme gives them the power ; to collect contributions of employer and employees,to register employer and employee and to ensure qualitative and cost effective healthcare services to contributors through the healthcare providers (HCPs).The HMOs role in the provision of health care and medical services to the enrollees of the scheme is key.They are to maintain a pool of Health Care Providers (Hospitals, Clinics, Dental and Optical Clinics, etc),for the benefit of the enrollees.
The NHIS is solely for federal government workers.There are different packages.A worker under the scheme is allowed to register a spouse and four(4) biological children.The least such a family can pay is N90,000. The other packages are calculated based on the consolidated salary and the establishment.And the NHIS spends N1,000,on each enrollee for administrative charge etc. There is also a provision for employers having ten or more than ten employees.They are required to register their companies and their employees with a HMO and to pay to the designated HMO contributions at such time and manner as provided in the guidelines issued by the NHIS Council or as agreed to with the HMO.Self employed people or others described as “Voluntary Contributors” and desirous of enjoying the benefits of the scheme are permitted to register and participate in the scheme by choosing a HMO of their choice.
Ibrahim Usman the Executive Secretary of the National Health Insurance Scheme (NHIS), has been frontal in his charge against the HMO’s.He has promised to avail Nigerians with what the HMO’s owe the “NHIS and the various healthcare facilities”. The Members of the House of Representatives Committee on Healthcare Services agree with him on the need to investigate the Health Management Organisations (HMOs) over alleged misappropriation of N350 billion,contributed by Nigerians under the National Health Insurance Scheme (NHIS).Chairman of the House Committee, Chike Okafor,has ordered a stop to further payments.But the Senate Committee on Health chaired by Senator Lanre Tajuosho,seems more concerned about the employment of Staff,and not the fraud.The Senate has ordered a probe into the allegation of employment Staff,on the grounds that it doesn’t meet the Federal character spread.
The fraud is perpetuated through and by numbers,as the HMOs and hospitals get paid based on the number of enrollees.The other way is the outright refusal to pay the hospitals,even though the HMO’s are paid three months in advance. Why are they not able to pay,especially as the money is available? Not only is the money available,but it is cheap money. HMOs get N750 per head whether or not the enrollee goes or doesn’t go to hospital.In a year an HMO can make N90million for doing absolutely nothing.But just as Nigeria doesn’t know the quantity of crude oil,that it exports so has the number of enrollees remained a mystery.Usman asserts that so far the NHIS has removed 21,000 ghost enrollees from the scheme thus saving the NHIS more than N350 billion moving forward.
Like the Berlin Conference,where the major powers sat and shared out Africa,the HMOs in 2005 equally sat and shared the Federal Civil Servants on equal basis to the existing HMOs for what they called “smooth and seamless activation of the Public Sector Social Health Insurance Scheme”,though with a caveat that any established case(s) of poor Quality Assurance and Relationship Management on the part of any HMO the MDA would be at liberty to switch.What the HMOs did,amounts to a breach of the fundamental rights of the enrollees to choose.This and other shortcomings portray them as buccaneers and not healthcare providers.
Though guaranteed payment,the charges against the HMOs includes failure to meet their part of the bargain,they owe the hospitals who in turn take it out on the patients.Thus defeating the objectives of the scheme – improved access to healthcare. Under the scheme enrollees are entitled to insured benefits,other services envisaged and enumerated include defined elements of curative care,prescribed drugs and diagnostic test,Maternity care for up to four live births for every insured person,preventive care including immune station, family planning, ante natal and post natal care etc.The opposite is the reality that enrollees are confronted with.
Like everything Nigeria,the actualization of universal health coverage for all Nigerians, particularly children, women, vulnerable groups and the unemployed across the country remains a mirage.Good thing the NHIS Executive Secretary, Mahmud Yusuf, has admitted these short comings on the part of the agency. It is a scandal that only four per cent of Nigerians are presently covered by the scheme, as against 60 per cent in our neighbouring countries.
The advantages of the NHIS- “pooled resources” for the benefit of all within the scheme,that will ensure equitable distribution of health care costs among different income groups,adequate distribution of health facilities,efficiency in health care services both in the public and private sectors will never accrue to nigerians,due to unbridled greed.The battle line seems drawn between Usman and the HMO’s,considering his resolve to recoup what they owe the agency and the hospitals.
Moving forward the NHIS management owes it to Nigerians to enforce the registration requirements for the HMOs.Any HMO without evidence of financial viability and insurance cover should be blacklisted.In the light of the revelations of ghost enrollees,the full disclosure of ownership has become imperative,as stories are being peddled of big wigs in the Federal Ministry of Health being the real owners of the HMO’s.The HMO’s are their automated teller machine.And it never runs short of money.
