In its bid to reposition and fulfill its mandate of providing coverage for all Nigerians the National Health Insurance Scheme (NHIS), Lagos Zonal Office, recently embarked on a series of education workshops towards improving quality care at the user-end by educating newly accredited healthcare service providers in the state.Towards this end Medical and Managing Directors as well as other high-level representatives of the newly accredited hospitals, pharmacies, medical laboratories, optometry, dental and physiotherapy clinics that were recently accredited under the Scheme, gathered, and were tutored on operational guidelines of the Scheme.
They were brought together to be equipped with requisite know-how of the NHIS benefit package for enrolees upon demand. The Lagos Zonal Coordinator of the NHIS, Mrs Awala Ebijuwa, said the purpose of the workshop is to enhance working knowledge of the NHIS Operational Guidelines for effective provision of healthcare services to enrolees.
In view of the National President of the Health Care Providers Association of Nigeria (HCPAN), Dr Umar Sanda, all hands needed to be on deck to enable NHIS achieve its mandate of Universal Health Coverage (UHC) in Nigeria.
In his lecture: “The roles and responsibilities of Healthcare Providers” delivered by Mr George Johnson, a Senior Manager and Head of Formal Sector in the NHIS Lagos Zonal Office of the Scheme, the various roles, responsibilities and obligations of Healthcare Providers were itemised towards provision of quality health care services to enrolees.
Abraham urged the providers to limit the scope of care they provide to their level of accreditation by the Scheme. He said Primary Healthcare Providers (PHCPs) are expected to provide primary healthcare services only. According to him, the referral system under the NHIS was crucial.
While emphasizing that all referrals must be accompanied with a referral letter, he warned against verbal referral by front-desk staff without allowing the enrolee to see the Clinician. Abraham pointed out that it was a violation of the Scheme’s provision for any health care provider to solicit payment in whatever guise or charge any enrolee an amount beyond the approved 10 percnt cost of drugs which must be calculated using the Scheme’s drugs price list.
Concluding the series of lectures at the Education Workshop, the Head of Planning, Research and Monitoring (PRM), Mrs Rita Nwadiogbu, an Assistant General Manager with the Scheme, explained the “Provider Payment Mechanism” utilised by the NHIS. Nwadiogbu said large scale purchasing of healthcare services has proven more efficient in the allocation of resources for health than the procurement of same otherwise. She explained the fee-for-service (FFS) payment mechanism employed by the Scheme for the payment of healthcare services provided at the secondary and tertiary levels of healthcare by accredited Healthcare Providers.
The Head of PRM went further to explain and emphasize that there are occasional cases of registered enrolees who may be brought to Healthcare Facilities not of their choosing in an emergency or who may present themselves for treatment outside their state of residence. She said that such cases must be treated on a fee-for-service basis after contacting the HMO.
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