The session was chaired by a member from Imo State, Mr. Chike Okafor. Under the scheme, the NHIS is mandated to pay capitation fees to health maintenance organisations, which will, in turn, pay health care providers.

On Wednesday, the Minister of Health, Prof. Isaac Adewole, and the Executive Secretary of the NHIS, Prof. Yusuf Usman, however, made an almost unanimous submission that the scheme had not been able to deliver sufficient services to the beneficiaries in the last 12 years.

The minister, who was represented by the Director, Hospital Services, Dr. Wampada Balami, said failing services over time had led to questions as to whether the HMOs were necessary.

“There is the issue that enrollees are used as conduit to channel revenues to HMOs. “Since 2005, over N381bn has been spent, but no service. The ministry supports this investigation by the House and it is interested in knowing whether the HMOs and health care providers are necessary,” he stated.

On his part, Usman described the operation of the scheme and the role of the HMOs as “monumental fraud.” He added, “Health care financing in Nigeria is a huge fraud. HMOs cash their cheques and they leave town to enjoy their money while Nigerians are dying. “This fraud is more than the fuel subsidy fraud with only 1.5 per cent of Nigerians covered since 2005.”

He also alleged that up to “23,000 ghost” enrolees were on the register of the HMOs, which cost the scheme N23bn. But the HMOs refuted the allegations, blaming the several breaches in the implementation of the scheme on improper coordination and structural defects in the NHIS management.

They made a presentation to the committee under the Health and Managed Care Association of Nigeria while the document was signed by the Chairman, Dr. Tunde Ladele. The association denied that N381bn was paid to the HMOs as claimed by the minister and the executive secretary. It explained that by the nature of the operation of the scheme, 70 per cent of the money was taken by health care providers and not the HMOs.

Ladele added, “To ensure measurable outcome, the public sector programme was designed to be prepaid by design and the primary health care provider is expected to bear the risk at the primary level with almost 70 per cent of the premium paid at the beginning of every month. “This is to provide qualitative services for the few that will access care within one month, while the HMOs bear the risk at the secondary and tertiary levels.”

The association made an analysis of the distribution pattern, saying N991.50 was paid to the HMOs per enroller per month. Ladele explained that out of the money, “capitation to primary providers was N750” or 60 per cent. Another N112.50 or 10 per cent was for “fee-for-service for secondary and tertiary providers” or 10 per cent, totalling N862.50 or 70 per cent.

He added that administrative fee for HMOs was N129 or 10 per cent; NHIS, 10 per cent; reserve fund, five per cent; and information technology, five per cent, bringing the grand total to 100 per cent.

Denying the position of the NHIS executive secretary, the association stated, “The ES has said at several forums that over N381bn has been disbursed to the HMOs. “We hereby emphatically rebuff the allegation as the 70 per cent disbursement was paid to the health care providers.

“As we speak today, the total number of enrollees on the public sector scheme is about 7.8 to 7.9 million, which is less than five per cent of 170 million Nigerians.

“Interestingly, out of the 59 accredited HMOs, only 40 are actively involved in the management of the scheme. The remaining 15 are basically doing private health insurance, which all the HMOs are very actively involved in.”

The HMOs accused the present NHIS leadership of leading a campaign of hatred against the HMOs in a “deliberate attempt to stifle, disrupt and destroy the health insurance scheme and poor knowledge of the workings of health insurance.”

Citing an instance, they added, “For example, the ES turned a prepaid scheme to a post-paid scheme as he is looking at it as monthly emolument.”

Speaking earlier, the committee chairman, Okafor, told the session that the purpose of the investigation was to unearth the truth in order to guide the House in taking further actions on the NHIS scheme.

He stated, “Nigerians have suffered so much in the hands of health care managers and providers. “Over 450 petitions were received from Nigerians over this issue of poor services. So, this hearing will lead the committee and the House somewhere. What can we do to resolve all the problems?”

Source: Swankpharm