Mandatory health insurance scheme excites Lagos

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Set for full implementation in June, the Lagos State Health Insurance Scheme is touted to be the biggest in the country. The huge volume of potential enrollees and the desire to avoid pitfalls that have bedevilled similar initiatives are some of the reasons for the seeming delay in rolling out the mandatory scheme, reports Associate Editor ADEKUNLE YUSUF

Barring any unforeseen hitches, Lagos is set to witness a burst of excitement. Expectations are high that, by the time the state begins full implementation of its health insurance scheme next month, it will dramatically change the entire healthcare delivery landscape in the Centre of Excellence.

As the law setting up the scheme stipulates, all residents – regardless of their financial or educational status – are expected to be captured by the compulsory scheme, which aims to be the first programme that achieves universal healthcare coverage (UHC).

At a recent briefing, Dr. Jide Idris, commissioner for health, and other state officials provided updates on the scheme and explained why its full implementation is slow in coming. No fewer than 120,000 persons have enrolled in the  health insurance, though not all are actively enjoying the service for now. They stressed that the state is not in a hurry to state full implementation of the scheme to avoid the mistakes that have marred similar laudable initiatives in the country, especially the National Health Insurance Scheme (NHIS), which has failed to achieve universal healthcare coverage after several years.

To avoid the pitfalls of NHIS, the  government decided not to toe the line of the Federal Government, which made its health insurance scheme optional. Having realised that countries that have successfully implemented health insurance scheme made it mandatory, Lagos has chosen to make the scheme compulsory for all residents.

“Countries that have successfully implemented health insurance scheme made it mandatory. Again, in those countries, a lot of money is being pumped into it, and then taxation is high so they can fund it. Our scheme is mandatory for every resident. That is why for the poor, the equity fund will cater for theirs,” the commissioner added.

While acknowledging that the task ahead is enormous, Idris is optimistic that the state can set the pace in UHC in the country. “The target for this year is to enroll one million people, but implementing health insurance scheme for over 20 million people is not easy. So, we are not in a hurry to do it so as to avoid mistakes. What we concentrate on mostly now is building the capacity of different agents who will take part in the scheme such as providers who will render service, field agents, ICT providers and ensure that the facilities conform with best practices,”  the commissioner.

Born in 2015 through a law enacted by the Lagos State House of Assembly (LAHA), the mandatory health insurance scheme is expected to change the entire health sector in the state.  Being a state-wide and pre-paid health insurance scheme that is mandatory, it aims to address core issues in healthcare delivery and provide financial protection against illnesses and attendant uncertainties inherent in out-of-pocket payment system. The scheme, which was launched with fanfare last December by Governor Akinwunmi Ambode, has not only made health insurance mandatory for Lagos residents, it also signifies the end of free healthcare for any segment of the population in the state, since the law envisages that no resident will be left behind by the time full implementation starts.

Enthusing during the launch last year that the scheme will deliver significant economic benefits to the state, Governor Ambode said having a statewide health insurance scheme will empower residents to have access to quality, affordable healthcare services.

“Beyond ensuring that we have a healthy population, the scheme will foster inclusion and an increase in the utilisation of hospital services, thereby creating employment opportunities for medical professionals. This will definitely have an impact on the economy of the state,’’ Ambode said. He also promised that the government would continue to commit resources to initiatives that can improve the state’s medical facilities and enhance the scope of coverage.

According to the General Manager of the Lagos State Health Management Agency, Dr. Peju Adenusi, the primary aim of the initiative is to provide quality healthcare service that is accessible and affordable to all. This will reduce, if not eliminate, out-of-pocket payment crisis, especially the financial catastrophe that often arises from prohibitive medical bills, she said.

She promisedthat every resident in the scheme would have access to quality basic healthcare. This is projected to reduce health issues or mortality rate by at least 10 per cent.

She disclosed that 150 private facilities and 44 public facilities had been accredited across the state after rigorous screening, adding that some hospitals are also completing the requisite formalities for accreditation. In essence, it means the state will have more than 200 standard health facilities for enrollees to choose from by the time the scheme rolls out fully. Since the scheme is compulsory by law for everybody, every enrollee has the freedom to choose where to access service – whether in private or public facility. Another feature of the health insurance is that any enrollee not satisfied with the services being offered by the provider also has a right to change his or her provider after complaining to LASHMA.

Adenusi warned that any provider found guilty would be properly sanctioned. Besides having a quality assurance team that will constantly engage in monitoring and inspection services, LASHMA boss has promised to institute a complaints management system where enrollees can provide feedbacks or voice complaints directly to hospitals, health insurance agents and the regulatory agency.

To enjoy a full complement of services on offer, all that is required is to pay a premium of N40,000 yearly for a family of six, which is the first unit of enrollment into the scheme. The law setting up the scheme defines a family as the mother, father and four children below 18 years. For families that are larger than six, enrolling every additional family member below 18 years attracts N6,000 per person per year. But if the person is above 18 , the additional premium per person is N8,500 per year. What it means is that if a family of six with children above 18 opts for the family enrolment, it will pay a premium of N40, 000 per year plus N8, 500 per person.

It is so too with any family that has a grandmother or aunty or nephew or any other members of the extended family who are categorised as individuals and not part of the family package because they are over 18. However, there is an accommodation for individual enrollment, as the law envisages that not everyone that ekes out a living in Lagos has a family residing in the state. For single individuals, it is for N8, 500 per year, but this can be upgraded any time after marriage with additional charges. For the sake of convenience, though yearly payment of premium is the most preferred, there are flexible payment options for enrollees to choose from. For a family premium that attracts N40, 000 yearly, quarterly payment of N11,500 and monthly payment of N3,850 are available. Also, an individual premium of N8,500 per annum is payable on quarterly (N2,450) or monthly (N820). Every premium is renewable yearly.

However, like most health insurance covers around the world, the scheme does not cover all health conditions. It will, however, cover treatment of common adult and childhood ailments like malaria, typhoid, hypertension, diabetes, diarrhea, asthma, measles as well as immunisation and maternal and child services such caesarean section where necessary, preventive healthcare services, selected non-communicable diseases and minor surgeries such as incision drainage, herniorraphy and appendectomy, among others.

As for employees in the state public service, enrollment is compulsory because the health scheme will replace the free healthcare being offered by the government. That is not all. While the state takes care of 75 per cent of the premium for its employees, each civil servant is expected to pay 25 per cent. And to further live up to public expectations, those behind the planning of the much-anticipated scheme said they are leaving no stone unturned towards bringing the informal sector on board, since this forms the bulk of potential enrollees. “We are also meeting the key stakeholders in the informal sector, which constitutes about 65 percent of the population because if you don’t enroll these people, this scheme will fail. We know the informal sector constitutes a huge chunk of the population, and that’s where the real work is.

“We have mapping which has details of everyone in the informal sector. Luckily, we have an agency of government dealing with them. We have met with the various union executives, and they have expressed interest. We also need to continuously reach out to them through persuasion. Some of them are already on one scheme or the other, but whether that scheme is better or not, it’s a matter of them knowing what we are offering,” Dr. Idris said.

Another segment of the population that has received serious attention during the planning stages of the scheme is the club of the poor or people who genuinely may not be able to afford the premium. An equity fund is said to have been set aside to cater for the poor and vulnerable by subsidising their premium 100 per cent. This is possible because the law stipulates that the state government should contribute a minimum of one per cent of its monthly consolidated revenue to the scheme. “That is why the law establishing it says a minimum of one per cent of the consolidated revenue fund of the state will go into a pool, which is an equity fund basically to address people who cannot afford to pay. That is to guarantee a financial protection for them. The contribution of the poor will be paid from that equity fund,” he explained.

This is already being tested in Makoko, a slum area where over 2,000 indigent residents have been enrolled into the scheme. Idris, who said operators of the scheme could approach the LAHA to increase the state contribution beyond one per cent, added that the state has also upgraded some facilities in Alimosho for the poor to access healthcare service.

He said  over 63 slum areas have been designed to reveal who is poor are to be captured into the scheme soon.

For residents who are already covered by any insurance package, such as NHIS, the state said it would not force them to join the new scheme. Instead, it would concentrate its attention on the people who do not have any coverage.

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