... ...
Home / Health / How HMOs Are Ending Out-Of-Pocket Payment For Health Services

How HMOs Are Ending Out-Of-Pocket Payment For Health Services

Over the last six years, healthcare delivery has come a long way such that  managed health care or purchase of a health insurance package is now the rule rather than the exception.

Since it was established under Act 35 of 1999 by the Federal Government, the primary aim of the National Health Insurance Scheme, NHIS, has been to provide easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.

As an alternative source of funding for healthcare delivery, the NHIS drives potential to secure universal access, although plagued by low coverage and slow progress, the need to strengthen existing structures, modify some areas, inject creative stakeholder engagement and facilitate rapid programme uptake at Federal, State, community, group  and individual levels has been the challenge.

But down the line, investigation reveals challenges prevail. More than 60 percent of total health expenditure in Nigeria is still out of pocket, with fees required to be paid at health faclities.

This has been a huge deterrent to a large proportion of the populacce from accessing healthcare. There are even instances during which households had to choose between buying medicine for a sick child and providing food for the entire family.

Managed healthcare

But with managed care by way of health insurance and similar pre-paid arrangements, protection from financial risks could be offerred according to need and at affordable rates.

Essentially three basic types of health plans have been on offer. They inclide  provision by the Health Maintenance Organisations HMOs, the Preferred Provider Organisations, PPOs, and Point-Of-Service plans, POS.

Findings reveal that of all three, services provided by the HMOs are  most preferred, not just because they are the most cost effective, but also because they provide more realistic options.

What the HMO does is to run Managed Health Care Plans designed to offer cost-effective medical care for health-seeking individuals, families or groups that are under contract with a network of providers either to deliver or to arrange for the delivery of covered services.

Precisely in 2012, there were 64 licensed HMOs in Nigeria and the penetration of health insurance was less than  4 per cent.  At that time, Nigerians were spending an average of N1.12 trillion on healthcare (in 2010), there was so much wastage, increasing trends of non-communicable diseases lack of focus on preventive interventions, the inefficient hospital systems encoraged the boom of medical tourism.

READ ALSO  Fayose Mourns Ekiti Doctors, Declares Three Days Mourning

For many years, the relevance of HMOs was lost to the average Nigerian and real progress was not made until  a recent comprehensive reappraisal of the industry.

While the NHIS may not be solving all the financial and funding problems of the health system in Nigeria, it is however providing financial risk protection options that are essential for the health care of the average Nigerian.

Service delivery: Experts say health insurance is about service delivery and not essentially about paying compensation for loss. “It is a financial instrument that makes service delivery possible, not necessarily as a health intervention,” they argue.

It is a welcome development , the approach that enables Nigerians to receive the healthcare services that they require, without the need to pay for such services at the point of care, is fast becoming the norm, relieving the enrollee from the barriers of access.

Out of pocket health expenditure remains a major proportion of private health expenditure in the country, (as high as 95.4 per cent) and the informal sector not yet covered.

Following the 2014 reaccreditation by the NHIS, the level of confidence of Nigerians in their potential was boosted appreciably. Lately, this boost is not unconnected with the increased level of investor interest in HMOs , based on their high yield and deliverables. To many potential enrollees in the country,  it is now clear what makes a successful HMO. Integrity and professionalism now define the HMO industry.

Online enrolment

One of the benefits of the upgrading and reaccreditation process is that choosing a reliable HMO in Nigeria has been made easier. Ordinarily, selecting a health HMO or a health care provider was tricky business. In the past, an enrollee had as much trouble  selecting a health plan as much as he/she struggled to pick the right HMO.

READ ALSO  England Manager Sam Allardyce Loses Job After Just One Game In Charge

Some choose health plans through their employer, corporate organisations or the NHIS, however, buying private health insurance or enroling in a social health insurance programme can now be done at the click of a button.

Avon Healthcare Limited (Avon HMO), that took up this challenge and developed the first online self-enrol and purchase health plan package in the country, believes that it’s all part of the outcome of the   response to the demand for innovative and more responsive as well as affordable and easily accessible, healthcare.

An intending enrollee can now purchase a managed healthcare package online by logging on to the Avon HMO website, select the preferred healthcare package, and register as directed by the step-by-step prompts.

In the views of the outfit’s Managing Director/CEO, Mrs Adesimbo Ukiri, the new online platform tagged  “Avon HMO Online” service, is convenient and set to revolutionalise the health insurance industry.

Universal Health Coverage: Ukiri said Avon HMO looks forward towards achieving Universal Health Coverage and that as their focus remains on the customers and is  constantly thinking of ways to make life easier and access to healthcare simpler. “We embraced technology and chose to update our website so that people can subscribe to a health plan whenever and wherever they are, 24 hours a day, seven days a week.

Our expectation three years ago at inception, was that Nigerians from all walks of life should be able to access good quality healthcare services when they need it, without financial constraint leading to unnecessary complications and fatalities. “With Health plans starting as low as N15,000 per year, Avon HMO has indeed brought quality healthcare services to the average Nigerian.

“By giving people the ability to buy and subscribe online, we are bringing convenient and affordable healthcare services to everyone.” With this innovation, it is hoped that uptake to health insurance within the country will witness a surge and all Nigerians will benefit from it.

About Adeola

Check Also

FG Stops Federal Universities From Charging Tuition Fees

The Federal Executive Council has barred all Federal university from charging tuition fees. Minister of …

Download Exclusives NG Android APP

Leave a Reply