Chairman of the Health and Managed Health Care Association (HMCAN), Dr. Tunde Ladele in this interview with Editors of Forefront, says since the appointment of Professor Usman Yusuf as Executive Secretary of the NHIS, the scheme seems to be making a complete turn-around in the negative direction. Dr Ladele also says that all Prof Yusuf has concerned himself with is how to fight everybody based on mindset, and therefore challenged him to prove any HMO that has defaulted within the terms of the Scheme. Excerpts
What is the real thrust of the matter between the HMOs and the management of NHIS?
I want to thank you for taking time out to clarify this issue. Since 29 July 2016, that Prof Yususf Usman was appointed, for the first outing he called the HMOs and lambasted them. We were quite surprised and shocked at such vituperation from somebody that was coming from nowhere that has little experience of the industry. Even if you have been told some things, it is necessary to run those things by the stakeholders. We kept quiet, and I tell you since then he has been going round, blackmailing the HMOs that since the scheme started the sum of 351 billion naira was paid to the HMOs and there has been nothing to show for it. We were wondering where he got his information from, because the law establishing the scheme is very clear. This is a social scheme for the Federal Civil servants, their spouses and children under 18. When the scheme was about starting in 2005, there was a stakeholders meeting, I have the documents, that states for this scheme to take off the way it was designed, let us get actualists. The actualists now look at 10% contribution of the basic salary of every employee through the cadres, like what it will amount to. They therefore went ahead to develop a customized health care package that will provide adequate coverage with 15% of their basic contribution. The healthcare package was developed. For the scheme to work as designed, they said there will be two risk-bearers- the primary health care providers which will be appointed by the NHIS. They will bear the risk at the primary level, since it is the cornerstone of healthcare delivery. 70% of the premium was earmarked to be paid upfront to the healthcare providers and this kind of scheme, makes it population based. So, individuals are at liberty to choose their preferred hospital, and the volume of release will transmit to how much will be paid to the hospital on a monthly basis. They said actually the volume of release that will migrate from primary to secondary and tertiary level is so infinitesimal, so small, a certain percentage was also earmarked for secondary and tertiary services and the HMOs are the risk bearers at that level. Now, what was not too clear to the current ES was this is health insurance, globally, insurance survives on commission. 1.5%of the premium was earmarked as the commission for the HMOs as the risk bearers at the secondary and tertiary level. By law, we are equally the fund managers. It is our duty to ensure that the hospitals provide good services. So, we established contracts with hospitals across the country. We deal with the hospitals directly on daily basis. The 1.5% was called admin fees. I also want to put it on record this afternoon, that this money at inception, the existing HMOs graciously volunteered that 0.5% of whatever was due to them be taken by NHIS and warehoused for two years, so as to develop a very robust ICT platform that would interface with the operations of the HMOs, such that the NHIS can view real time the operations of the HMOs. That money was deducted since 2005 till date. As at the last count it was well over 50 billion naira. You can quote me.
Now to your question. It is clear Prof Usman Yusuf doesn’t possess the intellectual capacity, nor the patience to run an organization. Because if he does, the first thing to do on appointment is to identify the key stakeholders and begin to interface with individuals to know the challenges and opportunities inherent, call a general meeting and seek solutions and way forward. You can then impose sanctions on erring members. Two HMOs were sanctioned before his arrival by his predecessors. I think it is high time the government asks him to come out with facts and figures. We are really angry at the whole approach. You can’t just label everyone a thief; we should check you that is pointing accusing fingers. If you point one finger the remaining are pointing back at you. If HMOs are culpable, name and shame them. He doesn’t understand that globally, government does not do business, but regulates business, creates enabling environment for it to thrive. The HMos was built on the PPP concept from the beginning. Government was to regulate, HMOs was to drive the scheme, a prepaid scheme. It’s a social scheme. It’s been confirmed that out of 2000 enrolees in a particular facility, about 20% of them will want to access care at the primary level, if a facility is being paid N750 per person every month, and we are paying for 2000 persons, that’s about N1.5 million every month. It’s not possible to finish that amount in a month, because it’s not the 2000 persons that will come. It’s a concept of subsidizing the health needs of the people by the contribution of both the rich and the poor. He doesn’t understand the concept. By July he will be one year in office. Let the public and government ask him his achievement. If he finds HMOs culpable let him name them. He has systematically indicted HMOs, instigated hospitals against HMOs to send letters to him that HMOs are owing them. We have told them not to be angry at such demands, only go to the accounts, when you get such letters, print out your evidence of payment, reply and send to them. As we speak he said he is embarking on rehabilitation of HMOs, in fact the first item on that list is that HMOs should get a letter of non-indebtedness from the healthcare facilities operating with them. To me it’s a clear case of witch-hunt and blackmail, because the least is 1000 hospitals across the country. So, he is saying the HMOs should travel round the country to get such letters. Even if it’s going to be done online, how many of these hospitals are actually online? The ones that get alerts on their phones still don’t acknowledge the receipt of the said funds. Now let me go further. The refund he talked about was not NHIS money; it was money meant to be paid to the HMOs at the beginning. The fee meant for us at the beginning was short of a certain amount and we have been clamoring for it. The business we do is population based. The fee being paid to us is for bearing the risk at the secondary level and the tertiary level. If we are paid 91 naira per person on 1000 heads, it translates to 910,000 naira. If out of that money the bill incurred was about 2 million naira who bears the risk? The HMOs of course. So, we kept bearing the risk and the money was being owed us. What Akingbade did was that he felt the pressure was much, so he sought approval from the minister, because by NHIS regulations, the Executive Secretary does not have approval limit beyond 2.5 million naira. So, Akingbade sought the minister’s approval for that refund, and it was done. One thing that should be clear is that there are 59 HMOs today. Those that are involved in the public sector scheme are not up to 30. So, majority of us are also into public sector and private schemes. Everything was less than 10 billion, and it was an accumulation of what was due to the HMOs. I also want to put it on record that apart from this, there was another amount of money we volunteered that NHIS should deduct, 0.5% of our admin fee. It is over 50 billion naira and it is still being deducted till today.
So was it because the former acting ES was able to get approval for the payment that you allegedly gave him and the minister a kickback of 1.2 billion naira?
I tell you, nobody gave money to anybody. A certain amount was paid to us, and we didn’t give a dime to anybody. For God’s sake, it’s not free money, it was outstanding money. Quote me anywhere, nobody gave a dime to anyone. These are sponsored blackmail, and I think we have had enough of it.
So where are they getting the bank tellers from?
Let us clarify this. We are Nigerians based in Nigeria. If kickback is going to be paid to the minister, will it be through the bank?
I wouldn’t know, you tell me
Seriously, if money would be paid, it won’t be into his account. They are fake and forged tellers. Does that money come from an individual? So who will coordinate the collection of the monies from the HMOs and now warehouse it in Akingbade’s account? Let us apply common sense here. The amount isn’t even uniform. How will it be done?
But you have an association?
The association account is open for auditing. No such amount passed into the account since we started. Most of the money we use to run the association is by annual subscription by members. We are urging the public to come up with an auditing platform to audit our accounts. There is no 1.5 billion there. It’s in Zenith bank.
Why did you have to go to court against the present ES?
We took him to court because when this scheme started, a lot of effort went into its setting up. The international community encouraged the Nigerians involved to begin to drive private health insurance while we are waiting for government to start the public sector scheme. Because the ILO states that every employer of labour must provide for the medical needs of their staff, and what the FG is paying their staff today is what is due to them as medical allowance, 10% of their annual basic salary. So, we have started private health insurance even before 2005. If we have a good regulator, a good ICT platform that will interface with the HMOs, I tell you there will be data to show the volume of private health insurance being run in this country. But those platforms were not created, instead the money was being kept and even squandered by some other people. So for us, the issue is clear. We aren’t interested in who becomes the ES, our concern is, the scheme should run. We took the ES to court because when he came in, he didn’t create the platform to know the HMOs. He probably came with a mindset and he kept talking down and insulting the integrity of the HMOs. We felt belittled and we took him up for defamation of character. The other case is for distortion and destruction of the scheme. The scheme by design was to be prepaid. Nobody runs post paid health schemes anymore. For us to make sure that this money goes seamlessly it was agreed unanimously that this payment be done quarterly. It will be smooth as a prepaid scheme. At some point the hospitals said they won’t treat enrollees anymore because of this reason-the funds were not being paid anymore and it distorted the scheme. This scheme was designed to eliminate paying from private pocket by the enrollee, and this was the level the thing came to. When Yusuf was appointed, he claimed to be the ES of enrollees. If that was the case, he needed to do the needful by working closely with the HMOs. The law is there, if anyone misbehaves, there are sanctions. In addition to that, for every payment the NHIS provides advanced guarantee bond. That means if I need to give you one million naira, I provide 0.5% of that amount as bond to secure that payment. Even if an HMO fails to pay that money to the hospital, the payment has been guaranteed. It is now left for the NHIS to instruct the insurance company to pay the hospital. There was no cause for all the hullabaloo. It’s just because he doesn’t understand what to do and he keeps grandstanding.