#PHC4UHC: Doctors identify loopholes in Lagos health insurance

Doctors performing surgery on a patient
Doctors performing surgery on a patient

Lagos State plans to roll out a state-run health insurance scheme next month. But doctors in the state are not convinced it will succeed under the planned arrangement.

The doctors identified several pitfalls in the draft document establishing the scheme, saying the document is “not yet complete.”

Moruf Abdulsalam, the publicity secretary of the Nigerian Medical Association (NMA) in the state, said the government did not carry the doctors along in the drafting of the document.

He said the association had several engagements with the government where it registered its displeasure with the model of the scheme.

Mr Abdulsalam represented the Lagos NMA chapter on Thursday at an interactive session between some Senior Executive Course participants of the National Institute for Policy and Strategic Studies, (NIPSS) and Civil Society Organisations (CSOs) in the state.

The NIPPS delegation is on a study tour of the state’s health sector. The visit is coordinated by NIPSS in collaboration with the Development Research and Project Centre (DRPC) through PACFAH@Scale.

“Despite not being carried along, NMA was present even at the launching of the health scheme. I believe we have registered our displeasure enough,” Mr Abdusallam said.

“The health commissioner has invited us for a series of meetings to see how the input of NMA will make the documents work. We registered our displeasure and made suggestions which were acknowledged and we all agreed that it’s not a complete document. But the state government has to just roll it out as it is presently.”

Lagos State Health Insurance

PREMIUM TIMES reported how government officials and experts in Lagos explained how the scheme will be implemented.

Enrolment into the scheme is categorised into family and single units.

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In family enrolment, the beneficiary is expected to pay a premium of N40,000 yearly per family of six while a single enrollee will pay N8,500.

The government said it subsidised the premium for public servants in the formal sector.

For family premium, civil servants will pay 25 per cent or N10,000 while the government pays 75 per cent or N30,000.

The stakeholders are optimistic that by the time the state begins the implementation next month, it will change the landscape of health insurance in Nigeria and become the benchmark for Universal Health Coverage.

According to Jide Idris, the state commissioner for health, about 120,000 residents have enrolled.

This newspaper also reported how technology will drive the progress of the scheme, according to the commissioner.

Pitfalls: Low Capitation

But the doctors said there are pitfalls.

The NMA official said one of the major drawbacks is that capitation that will be paid to service providers is very low.

“Even at our national level, we observed that some states are patterning their health scheme on the model of the NHIS which gives low capitation. Some states want to pay as low as N200. Lagos is planning to pay N365.

“This is one of the reasons NMA at the national level gave that directive that at any state chapter having issues with the arrangement should try and sort it out before the takeoff,” Mr Abdusallam said.

The NMA had directed all doctors not to participate in any State Health Insurance Scheme (SHIS) until there is “meaningful engagement” between the government and stakeholders.

The association observed that the manner some state governments are going about the establishment of SHIS lacks the necessary determinants for success.

Mr Abdusallam explained how low capitation will impact negatively in the uptake of the scheme in Lagos.

“The arrangement was that if an enrollee under family unit pays N3,333 monthly (40, 000 per annum), the health service providers will only be paid N365 capitation while the bulk of the money goes to HMOs and other administrative fees.

“The challenge now is that there is increased awareness and enrollees visit hospitals more frequently. At least two or three times in a month. That’s why providers are complaining because there is no way they can make profit and give quality service in this kind of arrangement.

“To treat simple malaria costs at least N3, 000. Now imagine when an enrollee comes to the facility twice in a month.”

Multiple Taxation

The official also faulted the scheme’s arrangement for civil servants, saying it encourages multiple taxation.

“A family is supposed to pay N40,000 but what we found in the model for the formal sector where the enrollee pays N10,000 subsidised premium is that if a man and wife are public servants, the fee will be deducted from both of their accounts amounting to double payment, because the scheme is mandatory.”

Mr Abdusallam also said the model does not allow enrollees to make the choice of Health Management Organisation (HMOs) under which they will be enrolled.

He, however, noted that the doctors are working closely with the government to address most of these challenges.

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