Some residents of the federal capital territory (FCT) have expressed different views about services offered by accredited health insurance hospitals in the territory.
The Federal Government launched the National Health Insurance Scheme (NHIS) in 2005 as a healthcare policy for better healthcare delivery to the public.
Established by Decree 35 of 1999 (now Act 35) operating as Public Private Partnership (PPP), it is aimed at providing accessible, affordable and quality healthcare for Nigerians.
The mandate of the scheme, which was reviewed in 2022 and its name changed to National Health Insurance Authority (NHIA) from NHIS, is to attain Universal Health Coverage (UHC) in Nigeria by the year 2030.
The mission is to mobilize and pool financial resources for strategic purchasing of affordable and quality healthcare for all.
NHIS is a social network programme established to provide easy, quality healthcare access to Nigerians at an affordable cost.
Health Maintenance Organizations (HMOs) were appointed as agents to NHIS to purchase healthcare services from public and private healthcare providers, thus, HMOs and NHIS work together, with the HMOs being regulated by the scheme.
However, some subscribers of the authority said that in Abuja on Sunday that they do not get satisfactory services, while others say some hospitals give them substandard drugs.
A civil servant living in Abuja, Mr. Kabiru Muhammad said that the delay and lack of attention had been a big challenge whenever he visited his health insurance hospital.
He said “my health insurance hospital does not attend to us after 8 a.m.; they will tell you it’s only emergency they handle, and even when it is an emergency, it has to be serious.
“For sicknesses like malaria, no matter how you are shivering, you are on your own.”
According to him, when he goes to the hospital, it will take more than three hours to see a doctor.
“As for me who is diabetic and hypertensive, if by chance l have malaria, they only send me for one test.
“I saw someone who is diabetic and has prostate enlargement and was asked to go for only fasting blood sugar, which is a test to know his sugar level. How about the enlarged prostate?.”
Muhammad also said that most of the drugs given to patients under insurance scheme are third category drugs, adding that “sometimes, the hospitals will tell patients that the drugs are not covered or they don’t have it in stock.”
He called on the authority to address the challenges faced by subscribers, saying that deductions for the scheme for Federal Government enrollees are done at source to ensure effective service but the enrollees do not get value for their money.
Also a judiciary staff, , Ms. Nneka Okoronkwo complained that the hospital she attends does not carry out kidney test, while other hospitals do, which are all government-owned.
Okoronkwo said that most times she used to buy her drugs outside as the ones they give are substandard.
She advised that government should put in place a strategy to monitor drugs administration and stressed the need to include the treatment of kidney, diabetes, cancer and eye problems into the scheme.
On the other hand, Mrs Joan Odafe, another enrollee residing in Abuja, said she is satisfied with the services of the authority.
According to her, she has no cause to complain even though she uses the service for only her children.
She said “I am satisfied with services offered by my insurance scheme hospital. Whenever I go to the hospital, I don’t pay for malaria test, and I pay only 10 per cent of the cost of drugs prescribed for me.”
On his part, Mr. Peter Nzeli, another enrollee civil servant living in Abuja, said that he had never accessed his NHIA hospital, and called for increased awareness on services of the scheme.
He also stressed the need for NHIA to educate the public, especially enrollees, about tests, services and ailments covered under the scheme, while calling for the treatment of sicknesses like cancer and heart diseases under the insurance cover.
Meanwhile the Managing Director of Ultimate Health Maintenance Organization (HMO),Mr. Lekan Ewenla, said that no health insurance package covers everything.
According to him, health insurance covers basic healthcare services only.
He said that what was responsible for some of the problems over the years was that healthcare providers and the enrollees were reluctant to seek information.
Ewenla said that even the HMOs that are meant to drive the programme do not have
proper training and fellowship to do so.
He, therefore, advised enrollees to call their HMOs for clarification in the case of any misunderstanding in the hospital.
According to him, another problem is that most of the enrollees do not exercise patience.
He said “when they go to hospital, most of them want to be attended to immediately, forgetting that they met other patients.”
On the issue of delay, the managing director said that the number of patients always
overwhelm the doctors, stressing that “there is nothing like substandard drugs.”
He explained that “people see generic drugs as substandard drugs, which is wrong.
The drugs are not inferior to branded drugs in anyway.
“The mindset of enrollees is that as soon as they ask for particular medication and they are not given to them, whatever is given to them is termed substandard, which is not true.”
According to him, the National Health Insurance Authority signed an agreement with 12 local pharmaceutical manufacturers and eight drug management organizations.
He said that the agreement is to ensure steady supply of quality and affordable medicines across healthcare centres.
He said that the drugs would be branded and the medication would be utilized in the programme, an act that would eliminate the challenges of perception of any drugs given as substandard.
At Nyanya General Hospital, Abuja, an official said no enrollee has been denied any treatment stated in the health insurance programme.
The official, who pleaded anonymity, said that no enrollee was delayed in accessing treatment, adding that “all patients follow the queue to see same doctor; be you NHIA enrollee or private patient.
