HMCAN canvasses review of health insurance guidelines to strengthen healthcare framework

Cynthia Ezekwe

The Health and Managed Care Association of Nigeria (HMCAN) has urged the federal government to review the operational guidelines of the National Health Insurance Act 2022 (NHIA) in order to promote inclusivity and create a sustainable healthcare framework. According to the association, the current guidelines are outdated and not aligned with the objectives of the NHIA, which seeks to provide universal health coverage to all Nigerians.

The association made these remarks at the joint annual general meeting (AGM)  of HMCAN and the Institute for Healthcare Finance & Management (IHFM), held in Lagos. The event also included a conference and induction ceremony tagged “Pitfalls in the 2023 NHIA Operational Guideline:Sustainability of HMOs as Strategic Stakeholders”.

According to HMCAN, the main goal of revising the NHIA operational guidelines is to strengthen the ability of health management organizations (HMOs) to effectively perform their critical role in achieving universal health coverage. HMCAN believes that HMOs play a vital role in the implementation of the NHIA, as they are responsible for managing the risk pool and coordinating the delivery of health services to beneficiaries.

During the event, Leke Oshunnyi, chairman of HMCAN and chief executive officer of AIICO Multishield HMO, voiced his concerns about the new guidelines, highlighting that they are at odds with the 2022 NHIA Act, particularly with regards to state-determined contributions for health maintenance organisations.

Oshunnyi noted that the current guidelines threaten the financial stability of HMOs and hinder their ability to effectively provide health insurance services. He explained that the ambiguity in the determination of contributions puts HMOs at risk of not being able to cover the costs of implementing the NHIA, which could lead to their insolvency.

He also highlighted that the current guidelines do not specify penalties for corporate organisations that do not comply with the mandate to purchase health insurance for their employees

Also speaking at the event, Muhammed Mustafa, former CEO of the National Health Insurance Authority, urged HMOs to adapt their business models to address the current and future challenges they face. He emphasised the need for HMOs to collaborate with one another and with other stakeholders in the healthcare sector to overcome these challenges.

Mustafa criticised the NHIA guidelines, arguing that the regulatory authority must justify the substantial payments required by explaining the value of the services provided. He also noted that the current guidelines do not provide a clear justification for the high premiums charged by HMOs, which puts a significant financial burden on both employers and employees.

“There is a need for dialogue between the NHIA and HMOs. They need to join forces in approaching the NHIA collectively, expressing the value they contribute and seeking clarification on financial requirements,’’ Mustafa said.

Pamela Ajayi, president of the Healthcare Federation of Nigeria, emphasized the importance of public-private partnerships (PPPs) in achieving equitable access to healthcare in Nigeria. She stated that the NHIS and the private sector must work together to develop and implement policies that benefit the public.

Ajayi further highlighted the need for a more inclusive healthcare system that considers the challenges faced by the private sector, including the migration of medical professionals and the high cost of doing business. She noted that the private sector contributes more than 70 per cent of healthcare services in some areas, highlighting the important role it plays in ensuring equitable access to quality healthcare.