Nigeria’s National Health Insurance Scheme delist 23 HMOs, grant 34 provisional nod

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target 10% fresh enrolle annually

The National Health Insurance Scheme Thursday announced that 23 Health Management Organisations, (HMOs) have been axed for failing to meet up with the minimum operational criteria expected of them.

This is as the scheme set a modest 10% fresh enrollment target annually.

The decision was reached after a validity test carried out on all the 57 HMOS operating in the sector.

All HMOs operating in the scheme are expected to renew their accreditation every two years, while some of them had their accreditation last since 2013.

According to the Chairperson of the Board of NHIS, Mrs. Enyantu Ifenne, only one out of the 57 HMOs actually scored 100% and is therefore granted accreditation to operate.

Ifenne who briefed the media alongside other members of the board, noted however that 34 others were granted provisional accreditation until they are able to fulfill all the conditions spelt out for the reaccreditation process, while 23 were denied reaccreditation as they failed to meet the minimum standard.

Explaining the criterial for scoring the HMOs, She said, “they scored the HMOs based on aggregation of criteria and at the first cut, only 11 out of the 57 HMOs scored over 70 per cent, 40 HMOs scored between 50 and 70 per cent while 6 HMOs scored below 50 per cent.

“The committee re-examined this and reduce the score further from 70 to 50 percent but only the Defense HMO fulfilled met most of the condition. But if we apply the law, none of the 57 HMOs fully met all the NHIS requirements for accreditation. We have advised that the 11 HMOs that were recommended for provisional re-accreditation should comply with specific critical condition within two to three weeks before they can be fully accredited.”

She further explained that the 46 HMOs who score below 70 per cent were disaggregated depending on the critical condition they did not fulfill adding that the six HMOs which score less that 50 percent were removed from evaluation. “That means they are not being considered for re-accreditation.”

Dr. Ifenne said another score they used as a critical irreducible minimum was the adequacy of payoff shares capital. “The payoff share capital for National HMOs is N400 million, zonal coverage is N200 million and the state coverage is N100 million. And this is a critical requirement because the Payoff capital share of a company is a requirement for accreditation and evidence of their financial stability.”

She also said HMOs were also required to submit their audited financial report from 2014 to 2016 but with criteria, six did not meet the requirements and one did not submit audited financial report and corporate affairs commission document, therefore removed from further consideration.

She added that the purpose of the conference was to bring to the notice of Nigerians that decree 35 of the scheme gives the council the power to re-accredit HMOs and lay out clearly the condition and processes through the operations and guideline that were drawn down by the Act.

She also gave some criteria considered for accreditation as; registration with cooperate affairs commission, adequacy of payoff share capital, current asset including fix asset, shareholders composition, company reserve, integrity of shareholders, composition of Board of Directors, current tax clearance of companies, current tax clearance of all Directors, appointment of audit fund and submission of audit account to NHIS as and when due, compliance with Pension PENCOM Act among others.

The new NHIS board Chairperson who also bemoaned the low number of people participating in the scheme said the board has set a moderate target of 10% increase annually in the bid to ensure universal coverage.

She said, “It is humiliating the fact that health facilities are reluctant to accept NHIS lives (Enrollee) is an indictment on NHIS as public entity because what we see with this reaccreditation is accumulation of regulatory failure. Accreditation should not be the only time we know that the company is bankrupt or nonexistence or sold to South African entity. If we were up and doing and on our toes in applying the regulatory powers giving us under the law, this should not happen. And this board is committed; this will not be allowed to happen. We have directed management to submit to us at the next board meeting the protocol and plan of regulation of HMOs. We will approve and put in place immediately this includes monthly returns, examine their accounts because we have the power to examine their accounts. So we will know when they are defaulting. We are committed to flipping the organogram. The value chain, currently, the NHIS at the top, the HMOs, the healthcare providers are the next rung and the enrolle are at the bottom and are caught t in the veil of the power tussle. Elephants have being fighting, grass is hurt. Grass is the people we call enrollee. I hate that word. Enrollee just reminds me as if they were conscripted. They have no choice, no actions that they have to take poor service whether they like it or not or opt out.”

She also noted that the board was prepared to change the current trend that places the enrollee at the bottom of the ladder. She said enrollee would be moved to the top of the ladder; stressing that the satisfaction of the enrollee would be the watch word in the new dispensation.

She also charged the HMOs to do their business transparently and accountability while making profit.”

She also assured them that the reaccreditation exercise was not meant to cripple any HMOs.

“With this shift, the healthcare providers will be held to account not only for the quality care but also for the humanity because from the information we have most in the scheme are treated as second rate patients. So we all NHIS, HMOs and healthcare providers have to work so that the enrolle is at the tip of the value chain and the enrollee becomes the first in the universal coverage.

“We are going to redefine the processes and focus NHIS to stand up to its regulatory function. The failure to meet our regulatory function is the reason why this plague has being spread, not validated and no punitive action taking. We want to change that, we must change that. The HMOs as you can see are doing their best but they have not been regulated appropriately, we must apply the tools. They are willingly to subject themselves to regulations if we stand up to our duties. I don’t think any of them, except may be a few rascals want to ruin this game. Similarly, the healthcare facilities beam torchlight all the time. I believe that many of them would rather deliver quality service, they are in position to do just that.”

In his remark, the Executive Secretary of the scheme, Prof. Usman Yusuf pledged that he will ensure that NHIS does the right thing moving forward and serve the people better.

“For a very long time, we have not being doing the right thing. I pledge as the Chief Executive of this agency, that I will do all I can to put the enrollee at the Centre rather than in the last position.”

He also denied the allegation of investing the fund of the scheme in business without due authorization, saying no Penney of the fund was invested anywhere in the country or outside the country.

Besides, he said the scheme has the right to invest its fund according to the law but it has not done that as the board has put a hold to the idea.

This was also colloborated by the chairperson of the board.

NHIS board also vowed to recover any money of the scheme that may be with the government, stressing that the money does not belong to government but the people.