The Federal Government is tinkering with the idea of reviewing upward the fixed payments to hospitals as capitation for health insurance services, The Nation learnt.

Capitation payments are payments agreed upon in a capitated contract by a health insurance company and a medical provider.

They are fixed, pre-arranged monthly payments received by a physician, clinic, or hospital per patient enrolled in a health plan, or per capita.

Disclosing this at the Annual General Meeting of the Board of Directors of Ultimate Health, a leading Health Management Organisation in the country, Dr. Lekan Ewenla, said the upward review will address the current situation leading to complaints by some hospitals.

Ewenla said review was last carried out in 2014.

He explained that the law stipulated that review of capitation be carried out every 24 months to accommodate inflationary and other economic trends. Ewenla, who is the Managing Director and Chief Executive Officer of Ultimate Health, said: “

So, as we speak today, the good news I want to share with us is that we are already interfacing with the leadership of the regulatory agency and they are already looking at the overall review of the capitation. As a matter of fact, before the last DG left, when the pressure was much, he increased the N128 for the HMOs bearing risk at secondary level to N146.

“But that was a far cry from where we’re going because the truth of the matter is the inflationary trend has gone up.”

He said there was a need for inflationary trends to be put into consideration for upward review of premiums so that services could continue to be provided by hospitals.

He explained: “At commencement, it was determined to be N550 per person per month in 2005 and the actuarial reports that were submitted to the regulator indicated that a recommended percentage should upwardly review the N550 or whatever 65 per cent within 24 months.

“This was to take care of the inflationary trend which was responsible for the upward review of N550 to N750 in 2014.”

He highlighted the review was not carried out in the stipulated two years which would have been 2007 but was carried out in 2014 instead, which saw the rise of premium from N550 to N750.

“Now the last review that was done was in 2014, we all know the exchange rate today and we all know that the bulk of the medications that we use in this country to provide services are imported.

“So facilities, hospitals, that’s our primary risk bearer no longer enjoy the scheme,” he said.

Ewenla stressed that health insurance is volume driven with provision for basic healthcare services to be covered, and with an amount attached to the services to be rendered.

He added that all of these parameters were put into consideration in developing the health insurance programme for Nigerians.

Chairman Board of Directors, Angela Ajala said Ultimate Health Services has recapitalised its capital base from N400m to N1bn in keeping with the provisions of the National Health Insurance Act 2022.

Ajala noted that the organisation went beyond the N750m minimum requirement stipulated by the regulatory body – the National Health Insurance Authority.

“We believe that if they say N750m, we can do a billion because we are not restricting ourselves to just Nigeria, we’re going beyond. So we need to expand our base and make sure that we can take on the expansion we’re doing.”

She said the previous business year was a mix experience as it was challenging and also successful. (The Nation)

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