Reports that health care providers plan to jettison all contracts with private health insurance companies across the country from January 31, owing to poor tariffs and huge backlog of debts is not only alarming but an evidence of the deep problems afflicting health care services in Nigeria.

For an institution considered so vital to national life, health insurance deserves more than the casual attention it has been getting.

As the saying goes, a healthy nation is a wealthy nation. The need to adequately fund health care providers through insurance cannot be over-emphasised; just as government, as the organ with the ultimate responsibility for welfare and wellbeing of Nigerians, should do everything possible to sustain health insurance schemes; and indeed, to raise the level beyond the present paltry state.

One of the major differences between a developed and a struggling country is the provision of health care to the citizens. While such services are highly organised, efficient and stress-free for the people in advanced countries, without recourse to their economic status; the services are poor and erratic in most developing countries, and those who benefit are usually people of means.

In Nigeria, like many of her counterparts in the African region, people die because of lack of support that can be obtained from health insurance, and because they could not afford a small fee to consult or buy drugs. There lies the significance of health insurance, which, sadly, is being threatened for strictly avoidable factors.

Indeed, health care has been roundly treated poorly, to the extent that providers suffer losses from the disparity between what Health Management Organisations (HMOs) offer as a premium on enrollees, and the increasing cost of services. These gaps raise question of integrity and commitment on the side of government as it has not lived up to its responsibility of supervising health insurance, which has consequently failed to function optimally in Nigeria.

One major blow to health insurance scheme, according to the Health Care Providers Association of Nigeria (HCPAN) is that members, that is, the private hospitals, remain the greatest and heaviest cross bearers of the scheme in the country. The body disclosed that about 7.6 per cent of total health care financing still remains out of pocket payments in Nigeria. Furthermore, the association regretted the way health care is being battered in the country owing to the actual valuation and determination that looks faulty and unacceptable to appropriate pricing tools for healthcare services.

To avoid the temptation of withdrawal of services, the President of HCPAN, Dr. Adeyeye Arigbabuwa, implored the HMOs to slightly adjust the existing contract documents using HCPAN tariffs benchmark for periodic review. He noted that the cost of medicals has skyrocketed. But the HMOs insist that before the costs can be adjusted upwards, they need to meet their principals – the insurance companies – to discuss more funding requirements. This means the HMOs are unwilling to adjust their tariffs any time soon. Another lingering issue is the HMOs woeful failure to off-set payments for services rendered, causing backlog of debts that, according to the service providers, takes a very long period to pay. Certainly, a lot is wrong with dealings with some of the HMOs as they have been operating with difficulty.

Over the years, government too has paid too little attention to the affairs of health care in the country, either directly by its failure to timely remit its contribution in insurance and those already deducted from source; or indirectly by not using the law to make HMOs effective. This has gone beyond incompetence. It is wickedness of the highest order to the poor beneficiaries.

Indeed, it has become fashionable that programmes designed for the masses lack strong government backing. What is emerging from the HMOs performance does not match the eloquence with which health insurance scheme was conceived. If the unfortunate threat by private health care providers to terminate their contract is allowed to happen, the consequence on enrollees would stand out like blotches, as they would have to pay out of pocket for services. This would be a major blow to the scheme knowing that so many poor Nigerians cannot afford to treat common ailments like malaria on their own.

The abysmal behaviour of the HMOs gives strength and substance to the mundane truth about health care in Nigeria. But virtually all the issues bordering on healthcare provision in Nigeria stem from the objectionable poor administration and funding by government or its agencies assigned the job. Hence, qualified doctors and nurses migrate to other climes not just for greener pastures but for professional fulfillment.

Without being prodded, government ought to recognise first, that the fundamental social objective critical to a productive polity is the good health of its citizenry. Also, the issue of integrity to HMOs has to be addressed as they are not living up to desirable standard. The country would be in deep trouble if HMOs are allowed to carry out their threat and put the poor masses and middle class in danger. The notion is that adequate healthcare in the country is available, but only for those who can pay. But Nigerians, being among the poorest in the world despite the country’s huge resources and potentials, cannot pay.

Government needs to tackle the funding problem of the National Health Insurance Scheme (NHIS) squarely and do a lot in the area of debt recovery for health care providers. Also, there is need for the government as regulator to intervene and make the HMOs work effectively so that the subscribers to private health insurance in Nigeria are not abandoned and left to suffer if hospitals drop HMOs. Importantly too, since prices are not stable and inflation is usually galloping, all stakeholders in the health care sector must agree to an arrangement that will address tariffs adjustment adequately instead of leaving a section of the sector to bear the brunt. Health insurance must be protected and nurtured in the country, in the interest of the masses of Nigerians.

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