By Talatu Maiwada
The National Health Insurance Scheme (NHIS) has expressed its determination to enforce quality delivery in hospitals across the country.
Mrs Nonye Unaegbu, Senior Manager, Head Formal Sector of the scheme stated this during a sensitisation and awareness programme organised for staff of the News Agency of Nigeria (NAN) in Abuja.
Unaegbu said the new Executive Secretary of NHIS, Prof. Usman Yusuf was determined to ensure that NHIS works for all Nigerians and for enrolees to enjoy quality health services in hospitals.
She said the agency has deployed members of staff to various hospitals as part of effort to ensure compliance with the required standards.
“The staff members will ensure that enrolees are well treated and that their rights are not trampled upon.
“For example enrolees are supposed to pay only ten percent of their prescribed drugs alone and not for the entire treatment because every other cost incurred is covered by the capitation.
“We also want to eliminate out of stock syndrome in our hospitals where enrolees are told that certain drugs are not available because they have all been paid for,’’ she said.
Unaegbu said the Health Maintenance Organisations (HMOs) have also been mandated to sensitise various ministries, departments and agencies on the rights and benefits of enrolees.
She warned that the scheme was set to sanction any defaulting hospital or Health Maintenance Organisations that goes against the standard.
Mrs Gladys Iroegbu, Regional Manager, Managed Health Care Services, an HMO, in her lecture explained that the organisation was out to sensitise enrolees on their rights and benefits.
Iroegbu said the NHIS presently covers the formal sectors which are federal government workers, informal sector through voluntary contribution of N15, 000 per annum and the organised private sector.
“We are acting as advocates to educate the public and our enrolees on the various groups covered by NHIS, the benefit packages as well as the exclusion packages available in the scheme.
“We are also creating awareness on what enrolees can do in times of difficulties in accessing care in hospitals, when they need clarification or during emergency situations,’’ she said.
She mentioned some of the benefits to include, Patient care, drugs, maternity care for up to four live births, immunization.
Others include consultation with specialists such as physicians, dental surgeons, pediatrician, and gyneacologists among others.
Iroegbu mentioned that the exclusion packages which are not covered by the NHIS scheme comprised of partial and total exclusion.
She explained that in partial exclusion the HMO pays 50 percent and the enrolee pays 50 percent of the medical bill such as dialysis and life threatening emergencies.
Iroegbu further said that total exclusion comprised of epidemic, family planning commodities, open heart surgeries, congenital abnormalities, drug abuse, cosmetic surgeries among others.