Medical Practitioners’ Raises Alarm Over Delay In Remittance Of NHIS Monthly Capitation Scheme

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Yakubu Busari

The former Chairman of Nigerian Medical Association, NMA, Plateau state branch, now the chief Medical Director of Sauki Hospital in Jos ,Dr Daniel Gana has raised alarm over delay in remittang of the NHIS monthly Capitation scheme of the federal government policy on health maintenance organizations to hospitals.

Gana noted that federal government pledged to ensure more Nigerians come under the coverage NHIS Scheme established under the National Health Insurance Scheme Act, Cap N42, Laws of the Federation of Nigeria, 2004, which is aimed at providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.

He reiterated that the, NHIS in their agreement said government is  totally committed to securing universal coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians, especially for those participating in the various programmes/products of the Scheme.

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Dr Gana disclosed this in an interview with our correspondent at his hospital , Sauki hill station junctions Jos North Local Government Area, of Plateau State.

He expressed worried that some cabal or rich influential Nigerian have hijacked were money will be deducted for NHIS and are remitted such money monthly to HMO close to the member of the family at the end federal government transfer its each of the health providers

He pointed out that the scheme was introduced to all employees with the little deduction from the monthly salary as low as 1% to enable them access medical health care delivery.

Dr Daniel Gana cautioned that, since February 2017 over 90% of their members from the private and public hospitals who key into the National Health Insurance Scheme (NHIS)are yet to receive money  from monthly capitation of federal government.

He maintained that with the escalation cost of drugs which has been threatened by delay in January most medical practitioners cannot manage over 50 companies and all the association of general medical practitioners are suffering untold hardship with failure to comply the earlier agreement reached on monthly Capitation.

He stressed that the nonpayment of health maintenance organization (HMO) which was imitated  by federal government during regime of president Olusegun Obasanjo in 2006 for national health insurance scheme as part of effort to ensure universal coverage to all federal civil servants across the country .

According to him, those targeted for the first phase they include, Soldiers, prison warders, Nigerian police force and all employees from federal government pay roll to constitute 1% population at that time when the ideas was conceived through NHIS .

Dr Gana lamented that since 10 years ago when the price of medical facilities were low but now the price of medical drugs has skyrocketed with over 100% increase compared to the last two years when thing keep increasing.

Dr Gana revealed that the contributions paid cover healthcare benefits for the employee, a spouse and four (4) biological children below the age of 18 years and more dependents or a child above the age of 18 would be covered on the payment of additional contributions from the principal beneficiary.

He, however, explained that children above 18 years who are in tertiary institution will be covered under Tertiary Insurance Scheme.

He decried that since the Out-patient care, including necessary consumables; Prescribed drugs, pharmaceutical care and diagnostic tests as contained in the National Essential Drugs List and Diagnostic Test Lists; Maternity care for up to four (4) live births for every insured contributor/couple in the Formal Sector Programme; Preventive care, including immunization, as it applies in the National Programme on Immunization, health education, family planning, antenatal and post-natal care; Consultation with specialists, such as physicians, pediatricians, obstetricians, gynecologists, general surgeons, orthopedic surgeons, ENT surgeons, dental surgeons, radiologists, psychiatrists, ophthalmologists, physiotherapists, etc.; Hospital care in a standard ward for a stay limited to cumulative 15 days per year.

Thereafter, the beneficiary and/or the employer pay.  However the primary provider shall pay per diem for bed space for a total 15 days cumulative per year. Eye examination and care, excluding the provision of spectacles and contact lenses; A range of prostheses (limited to artificial limbs produced in Nigeria); and Preventive dental care and pain relief (including consultation, dental health education, amalgam filling, and simple extraction).

A patient may be referred from a Primary to a Secondary Service Provider due to need for specialized investigations, for medical/surgical reasons or other services – diagnostic, physiotherapy etc, or from secondary to tertiary level.

Approval by the HMOs is necessary, except in emergencies where he cannot be reached and notification of such should be served within 48hrs.

Referrals should be to the nearest specialist as contained in the list of NHIS registered providers in the area.

He lamented that the health providers major challenges is were hospitals are battling with running bills due to escalated rising price of medical drugs with delay in January for almost 3 weeks .

The state coordinator of the National Health care insurance scheme, NHIS ,Plateau said, government had change service providers to officially write them on any defaulting company that failed to remit money to them.

According to her, if any  provider is complaint it’s for  them  to ask their HMO why remittances delay ,because we only deal with them directly .

The state chairman of the association of medical practitioners plateau state branch, Dr Tajudeen Adetunji Yusuff confirmed that most of these HMO refused to upsets the hospitals bill especially to secondary providers.

He explained further as of last year they used to enjoy prompt payment from the health providers but this 2017 there is sudden change, New Era hospital was just paid that of February on the 23rd.

Dr Yusuff complained that with the rising price of medical drugs in the market due to dollar and the exchange rate which had force this increase, he pleaded with the HMO to be  prompt remitting funds to the service providers.

He urged the HMO companies saddle with the responsibility payments to be prompt so as to provide qualitative NHIS ,debunking the alleged statement that there is no  defaulter’s but he appeal to HMO to be prompt.

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