Participants in the National Health Insurance Scheme are calling for better services and a more streamlined process, as they currently face difficulties accessing healthcare.

These concerns were voiced by residents of the FCT during interviews with the News Agency of Nigeria in Abuja. They emphasized the need for the National Health Insurance Authority to focus on providing value-driven services.

Introduced in 2005 to improve healthcare accessibility for the public, the NHIS was established under Decree 35 of 1999 (now Act 35) as a Public Private Partnership.

Its goal is to offer affordable and quality healthcare to Nigerians. In 2022, the scheme was reviewed and renamed NHIA, with the mission of achieving Universal Health Coverage in Nigeria by 2030.

The NHIA aims to gather and allocate financial resources for the effective purchase of cost-effective healthcare services. It functions as a social network program designed to offer convenient access to quality healthcare for Nigerians at reasonable prices.

Health Maintenance Organisations were appointed to procure healthcare services from public and private providers, and they work in collaboration with the NHIS.

However, enrollees have reported receiving substandard treatment from accredited hospitals. Some have complained about long wait times to see a doctor, while others have noted that certain health conditions, such as cancer or diabetes, are not covered.

An enrollee and civil servant named Mrs. Ese Williams shared her experience of being referred to another hospital for further assessment, only to face delays due to the need to provide treatment codes for each service.

Williams said, “The worst part is that when requests are sent to HMOs, they do not respond on time. It takes more than three hours to respond and the sick patient keeps waiting, after leaving his/her house early to access treatment. It is frustrating.”

Another civil servant, Ms Julia Steve, who also resides in Abuja, stated she abandoned the hospital assigned to her to access medical care under the scheme and has always paid her hospital bill as a private patient.

“This is because of poor services and the way some hospitals treat patients under the scheme.

“I don’t know why some accredited NHIS hospitals keep complaining that money has not been remitted to them, while drugs are always not available,” she lamented.

She stated that she hasn’t utilized the service in nearly eight years because of the hospital’s indifferent approach. As a result, she urged the government to oversee hospitals and HMOs to ensure they are adequately serving their enrollees.

“If they are monitored, those not doing well should be delisted,” Steve restated.

Another participant, Mr Emeka Ojiofor, mentioned that the insurance policy aims to ease the financial burden on individuals when it comes to health expenses. He called on the government to increase awareness about the scheme so that enrollees are informed about the services covered under the program.

He suggested that the NHIA should work directly with hospitals instead of going through HMOs to streamline the process of obtaining codes before receiving treatment. Dr Lekan Ewenla, the CEO of Ultimate Health, proposed optional guidelines to address the issue of codes, where primary providers can refer enrollees for secondary level care with a pre-authorization code issued promptly by HMOs.

Regarding delays, he noted that healthcare facilities tend to use codes obtained in January until March and other services over the years.

He emphasized, “Code given for Caesarean Section should not be used for fibroid. HMOs keep getting bills that are not within the approval code. Code given for specific treatment should be restricted to only that treatment.

“We have seen a situation whereby a facility will ask for a code to do appendicostomy and they will extend it to other services. And by the time they are sending the bill that is meant for N80,000, you will see a bill of N325,000 coming from the facility.”

The Director-General of NHIA, Dr Kelechi Ohiri, is currently examining the operational procedures of the authority in order to improve performance.

He emphasized the importance of addressing challenges within the health insurance system and emphasized the need for regulators to adhere to regulations and prioritize important matters.

He also recommended that enrollees should keep a record of their health providers’ phone numbers and effectively communicate with their HMOs.

Cautioning, “Any HMO that is not reachable should be queried.

“On the issue of inferior drugs, the scheme introduced the prescription of generic medications, which people assume are inferior drugs, but they are also as good as the branded ones.

“NHIA has initiated a process of branding medications that would be utilised on the health insurance programmes. You will see the package as NHIA medications and it will eliminate the perception of generic medications.”