Some enrollees of the National Health Insurance Scheme, NHIS, on Friday decried the non-availability of prescribed drugs and frequent referrals by healthcare providers under the scheme.
The enrollees made the complaints in separate interviews with the News Agency of Nigeria in Lagos.
A Journalist with NAN, Moses Omorogieva, urged NHIS to direct all Health Maintenance Organisations, HMOs, to pay their outstanding payments to healthcare providers to encourage them to boost their service delivery to enrollees.
Mr Omorogieva attributed the frequent referrals, non-availability of drugs and poor attitude of NHIS healthcare providers to non- payments of claims to the healthcare providers.
He said that his family members were refused treatment at Gbagada General Hospital in Lagos due to non-payment by their HMO.
According to him, the hospital in recent times no longer pay attention to NHIS enrollees like before.
Mr Omorogieva said that many ailments that were formally covered by the scheme were no longer being treated at Gbagada General Hospital.
“Most times, you see the doctor, virtually all the drugs prescribed will not be available at the NHIS dispensing pharmacy.
“Common tests that the scheme covered before like X-ray, Scan, and others are no longer covered by the NHIS healthcare provider at Gbagada General Hospital.
“I went there recently and the doctor prescribed some malaria drugs and high blood pressure drugs, but the NHIS pharmacist referred me to general pharmacy to buy as they do not have the drugs.
“I am calling on NHIS management to investigate why HMOs owed their healthcare providers.
“Last year, the same Gbagada General Hospital refused to attend to Managed Healthcare HMO patients because they owed the hospital,” he said.
However, a source in the hospital told NAN that the HMO owed Gbagada General Hospital 2018 bills, hence the hospital refused to treat its enrollees.
Gabriella Ezenwa, an Administration Staff of National Orientation Agency, NOA, complained about the low-quality drugs given to NHIS enrollees.
Mrs Ezenwa said there was the need to improve on the quality of drugs dispensed at NHIS pharmacies.
She expressed regret that NHIS health providers never had drugs prescribed by doctors, but would provide you with a lower quality drug or refer you to buy the drugs outside.
Mrs Ezenwa said there was need for the scheme to create awareness on enrollees’ rights as well as the responsibilities of the HMOs, which she said, must be spelt out.
She also called for good relationship and proper monitoring between the HMOs and the healthcare providers.
“The issue of monitoring is very important because sometimes you discover that between the HMOs and service providers, there seems to be missing links,” she said.
She also urged the NHIS management to be more committed to developing an efficient system that would ensure enrollees’ satisfaction.
Reacting to the development, Godwin Ekamen, the Head, Business Retention and Development, Managed Healthcare HMO, said there was an ongoing account reconciliation between the HMOs and healthcare providers to rectify all payments regarding the NHIS services.
Mr Ekamen said that the reconciliation, which started some months ago, would be completed before the end of the year or within the first quarter of 2020.
He debunked the misconception by some enrollees that NHIS drugs were mostly substandard and of low quality.
“There is no substandard or lower quality drug at any NHIS dispensing outfit. Drugs come in generic forms. If NHIS pharmacy did not have the exact prescribed drugs, they can give a branded drug of the same family.
“And if a healthcare provider refers an enrollee outside to buy drugs, it is your responsibility and right to call your HMO or NHIS at the spot so that they can engage the healthcare provider to find out why the referral.
“On no account is an enrollee supposed to be referred outside the hospital to buy drugs even if the drug is not available at NHIS pharmacy, it is expected that the healthcare provider gets it from the general pharmacy,” Mr Ekamen said.