Health Care Providers Accuse HMOs of bad faith

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February 26, 2006/independent




The National Health Insurance Scheme (NHIS) has once again been placed under the spotlight, as players in the scheme have complained of poor roles separation and contract limitations. This was highlighted on Thursday when health care providers in the scheme pointed out some areas of misunderstanding with the Health Management Organisations (HMOs).

National President, Health Care Providers Association of Nigeria, Dr. Iseoluwa Aworinde, who spoke at the on-going first West African Health Summit at the Lagoon Water Front Restaurant, Lagos observed that two key payers in the scheme, HMOs and the Providers, by registration under the scheme, are eligible to enter into contractual agreements, pointing out that the HMOs are the principal drivers of the scheme.

Aworinde, however, pointed out that a health care provider could only enter into such agreement with an HMO that has patients for them.

“The fact that you have been registered by the NHIS does not mean you will have enrollee. This was an area that created some friction between the HMOs and some providers,” the Health care providers national president said.

He disclosed that the providers were agitated by the inability of the HMOs to provide them contract forms nor the list of enrollees, adding, “The providers could not appreciate why the HMOs did mot send both the agreement forms and enrollee list after they had been registered by the NHIS.”

Aworinde noted also that it is the patient that determines the relationship between the HMOs and the providers.

“The enrollee has to first select your facility before your can enter into agreement with any HMO,” he further stated. Some of the functions of registered health care providers as spelt out by the law establishing the NHIS include provision of out-patient care, drugs prescription and diagnostic tests, consultation with specialist, among others.

Meanwhile, the president of the health care providers has also called for a sit-up among his subjects.

He noted that the obligations of the providers as found in the list of functions should be adhered to as a guide of operation by the providers.

He called on all health care providers to take Malpractices Insurance with NHIS approved insurance companies.

Aworinde also urged providers not to stray away from evident-based treatments in taking care of their patients.

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