The Health and Managed Care Association of Nigeria (HMCAN) has urged the Federal Government to overhaul the operational guidelines of the National Health Insurance Act 2022 to foster an inclusive and economically viable healthcare framework in the country.
The association stated this at the Annual General Meeting of HMCAN and the IHFM’s conference and induction ceremony with the theme “Pitfalls in the 2023 National Health Insurance Authority NHIA Operational Guidelines “Sustainability of HMOs as Strategic Stakeholders” held in Lagos recently.
According to HMCAN, the goal is to enhance the capacity of Health Management Organisations to efficiently carry out their roles as crucial contributors to the achievement of the Universal Health Coverage Scheme.
The association’s Chairman and the Chief Executive Officer of AIICO Multishield HMO, Dr Leke Oshunnyi, expressed concerns about the new guidelines, noting that it was in conflict with the 2022 NHIA Act, particularly regarding state-determined contributions for Health Maintenance Organisations.
Oshunnyi said, “There are inconsistencies in the guidelines, emphasising the Act says the remit of four percent of all the premiums collected from private health insurance to the NHIA quarter. No regulator of insurance requires the operators to remit four percent of their hard-earned revenue to it.
“There are no penalties for non-compliant corporate organisations which fail to purchase health insurance for employees and it designates states to decide contribution amounts, but the guidelines indicate that the NHIA will determine them instead.”
He underscored the necessity of aligning new guidelines with the Act, noting that the current guidelines put the financial stability of HMOs at risk and impede their effectiveness in providing health insurance.
Also, the former Chief Executive Officer of the National Health Insurance Authority, Dr Muhammed Mustafa, advised HMOs to revamp their business models through collaboration to overcome current and future challenges.
He criticised the NHIA guidelines, urging the regulatory authority to justify substantial payments by explaining the value of services rendered.
Mustafa averred, “There is a need for dialogue between the NHIA and HMOs. They need to join forces in approaching the NHIA collectively, expressing the value they contribute and seeking clarification on financial requirements.”
He emphasised the significance of collaborative exchange, stressing that the discussion should be mutually beneficial and not skewed towards one party.
Also speaking, the President of the Healthcare Federation of Nigeria, Dr Pamela Ajayi, stressed the crucial role of private-public partnerships in ensuring equitable healthcare access in Nigeria, especially in advancing the Universal Insurance Health Scheme.
“There is a need for a more inclusive healthcare system, addressing the migration of medical professionals, and recognised the private sector’s significant contribution of over 70 percent in certain areas,” she added.
Ajayi called for a strategic collaboration between the private and public sectors, urging increased investment in healthcare.
On her part, the Deputy Director at NHIA, Aisha Haruna, reassured stakeholders of open dialogue, urging proper channels for concerns about new guidelines.
She declared that the guidelines were aimed at enhancing healthcare access, stressing NHIA’s commitment to collaborative improvement in Nigeria’s healthcare system.