HEALTH

Doctors Stand up!_Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc

Doctors Standup!

DR I. I. Iseko, MBBS (ABU), MBA- Int Hlth Mgt (FRANKFURT), FMCP

In the words of the legend, Bob Marley

They can fool the people sometimes

But, they can’t fool all the people all the time!

Get up, Stand up

Stand up for your rights

Don’t give up the fight

All that glitters is not gold

Half the stories have never been told

Now, you have seen the light

Get up, Stand up

Stand up for your rights

Don’t give up the fight

The NHIS pie

The most important stakeholders in the management of the National Health Insurance

Scheme (NHIS) are the patients and the providers. Unfortunately, for far too long, the NHIS

officials and the Health Management Organisations (HMO) have held sway, apportioning up

the NHIS pie with resultant poor results and no credible achievements. Well, apart from the

loss of colossal sums of money that has never been accounted for over the years.

Pitiable enrolment

The percentage of Nigerians registered under the scheme remains incredibly low and pitiful

even with the continuing poor indices of our health in the country. Nigeria remains one of

the worst countries in the world in terms of maternal and infant mortality. The aged fare

even worse!

Patients and providers (doctors, nurses, physiotherapists and other healthcare providers)

remain in the dark and are side-lined from decision making by the cowboys in control of the

funds for the lives registered under the NHIS.

Providers are paid peanuts and so serve commensurate poor healthcare to the clients. Yet,
we have spent huge sums of money for health yearly!
Time for change

For all our sakes, it’s time for change and health care providers must stand up and face up to

the sharks circling for blood and body parts. It is not the change in name that matters but

the operations of the scheme for the benefit of all Nigerians not just the powerful few.

The recent farce at the senate in the bid to repeal the NHIS act and replace it with the

Nigeria Health Insurance Commission or NHIC is testimony to the hegemony battles going

on.

Doctors stand up

All too often providers have been made the burden-bearers and penalized parties in the

poor promulgation of health insurance policy to their detriment and that of the Nigerians

they try to take care of under non-representative legislation and operational guidelines.

The new NHIC Bill seems to be towing the same line hence the call for an amendment and

cautious steps.

Here are ten demands for amendment by healthcare providers irrespective of association

(GMD, AGPMPN, HCPAN, CCMDs & NMA):

  1. Provider Input in Tariff Negotiations: Ensure that tariffs, rates and capitations to be used

are reached as a result of negotiations with the providers and/or his representing

professional body.

  1. Timely Provider Reimbursement for Healthcare Services Ensure that fee-for-service bills

for services given by healthcare providers are reimbursed in full by the HMO or Health

insurance scheme within fifteen days of submission and where partially paid, the same is

reconciled within thirty days of bill submission. While capitations must be paid no later than

three working days after commencement of the period being covered

  1. Criminalize & Penalize Non-payment and Late Payment to make the system sustainable.

Make it a criminal offense with stiff sanctions specified for HMO and/or Insurance scheme

operators who do not make payments for services or capitation utilized within the time

frame stated

  1. Patient Confidentiality Must be Protected. Ensure privacy, security and confidentiality of

patient-identifier data being shared between institutions

  1. Remember the Common Man. The Public Sector Social Health Insurance Scheme be

renamed Public Social Health Insurance Scheme to cater for general public and those not in

Public Service, Civil Service nor Organized Private Sector- i.e. the common man on the street

who wants affordable health insurance coverage.

  1. Establish Independent Health Insurance Tribunal Panel. Set up a permanent independent

tribunal panel to adjudicate in matters unresolved between the insurance

commission/agency/authority, Insurance schemes, HMOs and Healthcare providers chaired

by a competent Judicial officer to resolve cases within a thirty day maximum period in order
to ensure smooth healthcare delivery as some of the cases may have impact on life.
Expand Care to be able to accommodate World class medications. Essential Drug List of

the Federal Ministry of Health should be the minimum standard and not the ultimate

standard of drug use.

  1. Representation of Healthcare Professional on the Governing Council. That the council

governing the NHIC have seasoned medical professionals as part of its constituents to

ensure context of healthcare financing is clearly understood. We propose that

representatives of Nigerian Medical Association (NMA) representing doctors and Medical

Health Workers Union of Nigeria (MHWUN) representing all other health professionals be

included.

  1. Freedom of Association without Prejudice. Healthcare providers and HMOs must retain

the freedom to associate (or not to associate) with any party without prejudice.

  1. Regular Representative Tariff Review. Tariff should be reviewed on a yearly basis as a

minimum by a stakeholders committee to reflect the changing economic realities on

ground that could adversely affect service provision by healthcare providers as is the case

now where tariffs are left un-reviewed for years.

All provider groups are prompted to come together to ensure the acceptance of the 10

points detailed above.
This way we can together ensure the success of the scheme and its
sole benefit for the Nigerian patient.

The time is now!

Stand up and be counted!

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