NHIS resolves tariff dispute between healthcare providers & HMOs

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NHIS resolves tariff dispute between healthcare providers & HMOs

THE National Health Insurance Scheme (NHIS) said it has amicably resolved the dispute between Health Care Providers (HCPs) and Health Maintenance Organizations (HMOs) in Nigeria.

The intervention of the agency, according to its Deputy General Manager, Press, Emmanuel Ononokpono – in a statement, was aimed at “avoiding possible service disruption.”

Recall that hospitals under the aegis of Health Care Providers Association of Nigeria (HCPAN) and other associate bodies had announced plans to drop Health Maintenance Organizations (HMOs) and imposed a new tariff structure for private health insurance from February 1, 2022.

The development, according to the statement, would have “created anxiety within the health insurance ecosystem.”

“At a meeting convened at the instance of the Executive Secretary of the National Health Insurance Scheme (NHIS), Prof Mohammed Sambo, the parties reached an interim but mutual understanding aimed at ensuring that a potential crisis is averted and persons operating health insurance on a private basis are not stranded,”the statement read.

Private health insurance is a practice  where HMOs buy health care for interested persons under pre-determined arrangements. Usually, it is outside NHIS system.

“In his remarks, Sambo stated that NHIS was the only legally recognized body that has the authority to come up with services tariffs for health insurance in the country, noting that the primary objectives of social health insurance was to limit the rising cost of health care services  and protect people from financial hardships of huge medical bills.

“Sambo, however indicated reservations that the system had tolerated HMOs to run “Private Health Insurance” which brought distortion to social health insurance implementation, expressing the optimism that the expected passage of the NHIS bill making health insurance mandatory will permanently resolve all such distortions. 

“Social health insurance is the only vehicle by which every Nigerian can access quality and affordable health care. Therefore any element that will threaten the smooth operations of social health insurance scheme in Nigeria must be eliminated”,the statement quoted Sambo as saying.

It added:”Sambo further noted that taking the issue to the public space in the manner which the stakeholders did left much to be desired, adding that disagreements can be resolved when parties  listen to each other’s positions and make effort to reach a compromise.

“Speaking on behalf of Health Care Providers, Dr Jimmy Arigbabuwo stated that HMOs had foisted their own tariffs on providers without regard for inflationary realities, insisting that HMCAN had not acted in good faith even as they provide services to their clients.

“For their part, the spokeman for HMCAN Dr Leke Oshuniyi said that members of the association were open to negotiations with the view to bringing the dispute to a close.

“At the end of the meeting, representatives of Health and Managed Care Association of Nigeria (HMCAN), Health Care Providers Association of Nigeria (HCPAN), Guild of Medical Directors, AGPMPN and other stakeholders agreed to propositions presented by the Executive Secretary of NHIS.”

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