Health and Managed Care Association of Nigeria (HMCAN) says efforts are ongoing to address stakeholders’ concerns as regards the operational guidelines of the National Health Insurance Authority (NHIA) Act 2022.
The Chairman of the association, Dr Leke Oshunnyi, said this in an interview on Tuesday in Lagos.
HMCAN is the umbrella body of Health Maintenance Organisations (HMOs), which promotes and protects the common interest of members transacting health insurance and management business in Nigeria.
The National Health Insurance Act was passed in 2022 by the Federal Government as part of efforts to ensure all Nigerians have access to affordable healthcare services.
The NHIA Act operational guidelines were launched on Oct. 10, 2023, to clarify the roles, responsibilities, and obligations of various stakeholders in the health insurance industry.
Oshunnyi, however, noted that the guidelines published were not received unanimously by stakeholders.
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“We have spoken about it with the Minister of Health and Social Welfare and the Director-General of NHIA.
“We asked them to put together a team to review the first draft of the guidelines to make sure it’s acceptable to all stakeholders.
“That process is ongoing and we are awaiting the outcome of the deliberations,” he said.
Oshunnyi highlighted adequate funding for the vulnerable group as one of the issues of concern in the guidelines.
“The Act stipulates that there would be a Vulnerable Group Fund for the care of those who cannot afford health insurance; as at the time the law was passed, 81 million people were officially classified as vulnerable.
“Between 2022 and now, that number has increased significantly. Who will pay for their care and how will the money be raised?
“That’s a significant issue that needs to be looked into,” Oshunnyi said.
He noted that some have suggested that tax on sweetened and unsweetened beverages should be used to fund healthcare for the vulnerable group, stressing that the tax was inadequate to fund the group.
“We must find a way of funding this mandatory health plan so that no one is left behind,” he said.
According to him, if funding is sorted, there will be mass uptake of health insurance services, accessible healthcare, and a healthier future for citizens.
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Oshunnyi further said that the remittance of four percent of all the premiums collected from private health insurance to NHIA should be reviewed.
“Most HMOs don’t even make 4 percent profit on their turnover, so asking them to pay 4 percent to NHIA as the guidelines propose would be punitive and unaffordable.
“Globally, the profit margin for HMOs is between one to five percent, other regulators charge between 0.5 to 1 percent from their operators,” he said.
The chairman stressed that the relationship of the apex regulator (NHIA) with the state social health insurance agency should be clarified.
“The law (Act) has defined the relationship but the guidelines do not appear to align with the law, there seems to be some ambiguity between the NHIA and the state health insurance,” he said.
Oshunnyi expressed optimism that finding a sustainable solution to the issues would boost health insurance coverage and attain the universal health coverage target by 2030.
NAN
