The new NHIA Act: We will soon start members’ sensitisation
Mr. Wale-Smart Oyerinde is the DG, National Employer’s Consultative Association (NECA). In this interview, he said Corporate Nigeria is satisfied with the Act. He further stressed the need to sensitise members of its Association on what the new Act portends for the industry.
What is your general assessment of the state of healthcare in the country?
Well, it is something that is open to all of us. Before COVID-19, we all may have different perception about the state of healthcare, what is happening in healthcare? Have we invested enough in healthcare issues or have we progressively turned our hospitals into consulting units? But when COVID-19 came, it exposed the generality of the situation in the context of our inability to maintain the basic protocols. Thank God that support came from the international community for us to start dealing with those challenges. Realistically, within the context of our population; within the context of investment in healthcare, we have not done very well as exposed by COVID-19 so nobody can contest whether we have done very well or not. Fundamentally, for all and sundry, we have not done very well. We have not invested very well. A lot of money has been spent on primary healthcare but yet, COVID-19 showed us that our level of preparedness is slow. With the investment that we have now, investment that was made during COVID-19 period, the expectation is that we have moved from where we were pre-COVID to another level of preparedness. At least, the infrastructure that we built; that were donated, that were refurbished, those infrastructure remain. Whether we now put them to good use is another thing entirely. But, by and large, we have not done very well within the context of provision for healthcare. They say health is wealth. So a healthy nation will probably be a productive nation. We just hope government will put more attention to the issue of healthcare. If another COVID comes or another disease; recently, there was conversation about EBOLA coming back. Can we say with boldness we are okay with the facilities that we have? I think we might not be able to curtail it. Even those in government are also aware that we are not okay because if government is aware that we have facilities that suffice for us, then, the president will not be traveling to Europe for medicals, the governors will not be traveling for medicals. The quantum of cash we spend on medical tourism will reduce drastically. It will also save forex for organized businesses; the manufacturing companies that are looking for forex. If we take medical tourism away from the pressure of forex, it reduces the forex pressure itself. And it is because it is a game of demand and supply. The more the demand for forex increases, the more pressure it puts on the naira and increases the value of dollar. The more forex you have available, the less the demand for it because it is going round. So less demand will reduce pressure and the value of naira will go up.
So, all these things have a collaborative effect on each other. Sometimes, those that are making policies just do not look at what the effect of the policies on two, three other areas of our lives. The policy option will be for any policy you want to come up with, let us look at what is the effect of it. If one policy can negatively affect two or three other critical areas of our lives, why continuing with that policy option? Our view is those policies that will not have negative effect of others of our lives, let us continue with them. So that is one area most people in the developed countries do their analysis. This is it. What will be consequences of this on that?
Look at our conversation now, we are talking about medical tourism. Look at the effect of taking away that pressure on forex from medical tourism? Look at the effect on other areas? So we have not really done well within the context of healthcare. But we believe we can do more.
As a body of private-sector employers, how is your Association dealing with the escalating cost of providing quality healthcare for its employees?
Employers are also Nigerians. They are Nigerians that have decided to take the risk of investing in this environment and that shows some level of high patriotism. If you can operate in this environment, with high cost of diesel, with high cost of inputs, you also have to make arrangement for your own security and so many other things yet, we are still operating in this environment, it takes some level of guts to actually do that.
Employers also face the challenges we all face as it were. We must commend employers, not because we represent them, but because of that resilience and doggedness. Hardly would you find a private sector organisation that does not provide HMO or provide an alternative to HMO services for its employees. And Nigerians being who we are also, everyone has one form or other alternative medicine that he or she uses. If you grew up in the village, there is no way one would not be exposed to traditional medicines. One must have taken agbo before. While those things have their consequences, an average Nigerian, when pushed to the wall will say “something that I have taken before, why now are you saying it will have any consequential effect on me”.
So employers have tried, they are doing HMOs and those who do not have HMOs are put in place some form of private arrangement with hospitals (retainership), some have in-house clinics. Essentially, employers have played their part very responsibly. But is it perfect? I will say no! Are all employers doing it? I will say likely no but we are sure that members of our association are at forefront of promoting quality healthcare for their staff. And it is a given; a statutory requirement for most responsible organizations and our members are very responsible organizations.
How is the cost telling on their operations based on the general use?
It will tell because the cost of an absent employee on the business is very high. The private sector is not like the civil service where if you like you come; if you like you do not, at the end of the month you are paid from the national purse. But for a business, it is from the revenue made in a month that salaries are paid. So if one staff is absent, it creates a gap on that business and the absentee staff’s lack of input affects the value chain of production for that day. Even a relief staff may not be as good as the staff. So when an employee is sick and does not come to work, it affects productivity and the bottom line. It is in the interest of the business that employees are healthy and that is why context in which businesses are taking the issue of healthcare. Even if you are cutting cost in other ways, you cannot cut the cost if healthcare because the foundation is life. Cutting healthcare cost, you are increasing your risk. If something happens to the employee, it may not augur well for the business. Also other staff may say if this can happen to a colleague, how much more me. So it can reduce morale and productivity among the employees. So healthcare is not what you can manage and employers have really played their part in keeping a healthy workforce. We have even gone the physical issues to mental health issues. Employers have played significantly on these issues. Providing all these is costly but the employers have been able to manage it within the context of current realities.
NECA was actively involved in the creation of health insurance system and even in the process of enactment of the schemes we have in the country today. Could you please highlight the role of NECA in the journey so far?
You know, from health insurance scheme to health insurance authority, before then, there was the fee-for-service or retainership arrangement whereby employees go to the hospital, get treated and the company pay the bill. Progressively, we had companies that could afford it setting up their in-house clinics. Then it became obvious that to actually maximize healthcare provision, you had to go the health insurance way. It becomes cheaper to pool funds for those who need to go the hospital. And we have paid our role by working with HMCAN, the healthcare providers. We have forged a collaborative partnership for the interest of everybody. So within the context of enlighten self-interest, we have done our part interacting with all stakeholders. We have played the balancing role to make all players to align. We will continue to do our part because it is the most responsible thing to do.
So far, what percentage of NECA’s membership has enrolled on health insurance schemes in the country? What challenges do your members face on the scheme?
No I will not give you a percentage because I cannot confirm that now but I can tell you that there are some employers that are outside of our scope. Some did not join us because we insist on responsible enterprise so if you are going to cut corners then you will some challenge relating with us. If you are not going to pay your tax, pension, NSITF, and generally comply with and be responsible with statutory requirements then it will be difficult being our member.
What we preach is responsible enterprise and these are basic requirements that all employers in Nigeria are expected to comply with so if you are not doing this and we have you under our roof, we are an accomplice. Yes, there might be some outside of our scope who are not doing health insurance but the new NHIA Act has made provisions for compliance and penalty. So, the expectation is that the NHIA will also do its part in driving compliance. We met with the DG of NHIA a few months ago and what we sought was collaboration in driving compliance among our over 4,000 members. All we want is compliance. It is a lot easier when we are the ones preaching the message to our members rather than NHIA itself. That way, there is no suspicion; we can leverage our goodwill and network. The tendency that our members will believe us is higher because we have built that trust over the years. This way, compliance will increase across board. You really do not legislate or force compliance. It is easier when you encourage and collaborate that way, people will voluntarily comply. Recently, we had one of the agencies that took a member-company to court. So we said rather than taking them to court using money you have not collected to pay the lawyer, to help you collect the money that you may never collect because it is when the company has the money to pay that you can collect it. That is a leakage in your pocket. So why not come to the table and let us negotiate how much and when to pay. That way everybody is happy and the relationship secured and sustained. So in essence, that is the message we have taken to NHIA that partner with us in this matter for a win-win situation for the agency and for Nigerians.
And the NHIA is responding to us. The DG has given us his word to collaborate with us. We are working on some programmes to jointly run just to give more publicity to the Act and get employers to understand the provision of the new law. There are still grey areas for employers to understand beyond the fact that it is compulsory. There are key issues to understand and that is oart of the conversation we will be having with NHIA. So, hopefully any time soon, we will roll out the interactions.
Apart from areas of the law that are not clear and require further clarification as you have just mentioned, would you say generally that your members are satisfied with the new law?
Yes, we are satisfied because we were a part of it. When a law is being crafted, if you are not satisfied, it is at that point that you raise your objection. Even if yours is a minority voice, let it be heard. It is not after the process has run its full course that you will now come and be raising issues. To some extent, that may be irresponsible. However, the beauty of it is that no law is perfect for all time. Change is constant and as things happen in the polity, if the circumstance change, then we should consider the situation and amend the law as appropriate. Hardly would you find a law that all the stakeholders agree and 100% comfortable with it. There will always be areas they may not be comfortable with but which are not fundamental. The same thing it is with the NHIA Act; we are satisfied with it, we are committed to its implementation but that does not mean there are not areas that we will continue to engage the Authority. We are very open to engagement and dialogue and suggest policy options. Our approach is not to criticize.
Less look at a provision of new law that mandates the Organized Private Sector, which your members fall under to migrate from their current private health insurance provider to government schemes. How would you react to this?
We are engaging. Engagement is ongoing. Someone says “if it is not broken, do not fix it”? Without prejudice to those some government agencies that are doing very well like PENCOM, NSITF, ITF, etc, one of our concerns is that if I have a system that is effectively well, why should I migrate to a system that is not tested or that the stakeholders are not comfortable with the stability? The truth of the matter is that most of privately-owned healthcare facilities are doing well and maybe better than the government–owned facilities. The best of the facilities you find in the private sector for example the one that Vice President went for treatment the other day. If a system is providing such quality facility for its staff, it will even be a disservice to the staff to move them from that quality-guaranteed system to one not tested. If you are already spending more to provide private health insurance then the business should be commended rather ask them to move.
But like I said, engagement is ongoing at the highest level to smoothen those grey areas because we are not fighting for ourselves, it is about Nigerians. What we want is a scheme working for Nigerians.
And the engagement will involve issues of seeming double regulation by federal and state agencies. All stakeholders would be involved to share their perspectives within the context of the direction we want to go. We have adopted this approach, method and platform before now in engaging regulatory agencies so we are confident we will agree and move forward.
Does NECA have any plans to mobilize its members to embrace the new law?
Yes, on our part we are ready. In fact before the end of 2022, we are planning an in-house closed knowledge sharing session with our members which would be a virtual session to share highlights of the Act and begin sensitization to the new reality. We plan to have one or two HMOs to join us in this session. And before the end of quarter of 2023, we would organize a formal interactive forum that we would invite the general public to NECA House. We may have it three or four geo-political zones so that everybody is on the same page. The NHIA also would be involved. To speak to employers, set expectation and clarify areas not clear. So it is a double-pronged engagement for us- a closed session and a bigger one with NHIA.
Currently, what challenges do your members face in this scheme?
Whether we like it or not, health insurance premium is a cost to the business. Yes, it may be a noble thing to provide health cover for the employees but it is still a cost to the business. And when premium is increased, it also increases the business cost. One of the challenges of business that I have mentioned is managing the hospitals. Sometimes when the staff goes to the hospital, the quality of care or service he receives is not the best at all. And who bears the brunt? It is the human resource person or whoever is in charge of HMO in the office. So quality of service is a major issue. We have a member-company that within 19months has changed HMO three times! And those are big issues for administration as you have to get staff to start the process of engaging another HMO all over again, you know, transition between HMOs. And after a while, employees start to complain about hospitals and poor service all over. All of this creates a bit of distraction for the business. So, internally, less of issues, but mostly it is the responsiveness of the operators- HMOs and hospitals- to the complaints that is the biggest challenge that we have.
And how are we managing it?
Well, we just keep managing it. Just like PENCOM that has opened the transfer window and the NCC that has opened the porting option, if any HMO is consistently not giving us service, we just till we run down the agreement or contract and then we change the HMO. Even us here, there was a time we went full circle- from one HMO to another and to another and then we came back to the first one (laughs). It is about health. If you take a staff head count and out of 15 employees, 11 or 12 are not satisfied with the HMO, what do you do? Except you have other interest in that particular HMO, you do not have an option but to change it. So we generally find a way round the whole process.
Ideally, what specific area would you want to see improvement in the scheme? The area might be beyond the control of the authority. It is more of the responsiveness of the operators. If I am having headache and I come to your facility, it means I can no longer bear or manage it. It means I am sick. And so the last thing I want is to be treated without care. It would be double jeopardy for some who is sick and managed to come to the hospital and be treated shabbily, without care or delayed. It is an area that commonly comes up in conversation with the operators. Some also allege that hospitals treat their private fee-paying patients better than HMO patients. This is not good for the emotion and psyche of the enrollee and can even render whatever care that is eventually given ineffective. People need to be treated as human beings. Cost, we cannot do much about that. We know healthcare is costly. It is so in every part of the world.
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