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HMOs In Serious Trouble As Private Hospitals Threaten To Drop HMOs

Private Hospitals have threatened to deny care to patients under Health Maintenance Organisations (HMO).

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The Association of Nigerian Private Medical Practitioners (ANPMP) made this known in a statement released on Saturday.

The national President of the ANPMP, Iyke Odo told newsmen about the development.

Odo advised HMOs to increase their tariffs and renegotiate the terms of the agreement.

He said failure to do so would force private hospitals from rendering services to patients with health insurance cover.

The ANPMP said the HMOs have until February 1, 2022, to meet their demands.

He explained that the hospitals are adjusting to the high cost of living in Nigeria.

The President said that as such, the cost of treatment at hospitals and clinics are affected.

The association lamented also that some HMOs are owing healthcare providers.

Odo called out the National Health Insurance Scheme (NHIS) for its lack of accountability.

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He said:

“Health providers have become burden bearers of the nation’s insurance project.  

“Due process, standards and accountability have been negated”.

He continued:

“Health insurance is managed care. But the only way its principles can stand is when the conditions necessary to drive a successful health insurance scheme are met. And they include appropriate premium pricing, appropriate service tariff pricing amongst others.

“Change in price occurs almost daily.

“Nigeria has not witnessed price summersault as it has done in the last two years.

“No cost of medication, medical consumables, medical devices, medical equipment, food items and general cost of living has remained the same.

“Nigerians are adapting and adjusting to spending more for everything else in the environment. But hospitals and clinics are rather expected to charge less than they were charging despite the obvious course of inflation.

“We appreciate the few HMOs that have yielded to calls from providers for tariff review as part of encouraging quality care at all times. For the wide majority which has not, I implore to embrace the moment.”

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He called for the establishment of a national minimum tariff to resolve the crisis.

The President for the Private Hospital Association referred to a joint strategic meeting held in 2020 between the:

  • Health and Managed Care Association of Nigeris (HMCAN).
  • Healthcare Providers Association of Nigeria (HCPAN).
  • ANPMP.

He mentioned that a call “for the establishment of a national minimum tariff to help stabilize and sanitize the crisis in our private health insurance scheme arising from the “price war” amongst HMOs”

“HMOs in negotiating premiums for the different insurance plans undercut one another, accept extremely ridiculous premiums they know will not pay for the providers’ services, just to secure the “business”.

“Such HMOs end up delaying claims payment, some fail to pay, others pay whatever they feel like paying and dare the providers. And yet, others have liquidated with the providers’ claims unpaid.

“This is why today, well over N15 Billions of providers claims across the country is trapped with the HMOs under various guises. Following that outing, the HCPAN constituted a joint tariff review committee to actualise the proposed minimum service tariff, and today, here we are.

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“The NHIIS is not favouring up to 10% of private providers on account of poor enrollment. The state support health insurance schemes have shortchanged you and me across the country.

“Private health insurance has made many of the providers’ mere labour workers, an inch away from slave labour. This is not health insurance. This is exploitation.

“This is an open war on the Nigerian healthcare system and a sure path to the poverty of providers. Much as we desire health insurance, our government should give us health insurance, not make beliefs or look-alikes. If we cannot have health insurance the way it is known to be productive and equitably beneficial, then it should be abolished until we are ready.

“This is a clarion call to all members and to all private providers across the country to use the recommended tariff and renegotiate their services agreements with their HMOs effective 1/2/22. The tariff is the minimum. You can go above it, but you should not come below it.”

Source: The Cable

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