30/07/23
DANIELS O G
The attention of the Lagos State Health Management Agency (LASHMA) has been drawn to two recent publications in the Business Day Newspaper of Friday, July 7 and Friday, July 21, 2023, titled: Lagos Sets Ultimatum for HMOs to Move Clients on State Insurance and NHIA Act: Lagos, Health Insurers Lock Horns Over Premium respectively, wherein it was reported that Health Management Organisations (HMOs) were mandated by LASHMA to move their clients to ILERA EKO and a dispute arose in respect of insurance premium payments.
It is rather unfortunate that these Publications contain a lot of distortions, misreporting and unfair misrepresentation that portray an unbalanced view contrary to the ethics of the journalism practice. As a stakeholder in Lagos State, Business Day should have sought the views of LASHMA before going to press. However, it is essential to put issues regarding these publications in the right perspective, and set the records straight as follows: 1. The National Health Insurance Authority (NHIA) Act 2022 in Section 13 provides that “for the purpose of providing access to quality and affordable healthcare delivery to its residents, States can establish and implement State Health Insurance and Contributory Schemes”. As of today, 36 States of the Federation, including Lagos, have set up their State Social Health Insurance Agencies. The NHIA Act further states that the minimum package of benefits to be provided shall be the Basic Minimum Package of Health Care Services as contained in the National Health Act in Lagos State, the basic minimum package of health has been named ILERA EKO, while the State Health Insurance and Contributory Scheme is the Lagos State Health Scheme (LSHS). Also, Section 31 of the NHIA Act gives authority to the State Health Insurance Agencies to determine the contributions payable by the formal and informal sector employees while Section 32 mandates employers to register and pay the contributions of their employees into the accounts of State Social Health Scheme Funds as specified in the State Health Scheme Laws. Therefore, the NHIA may not be in a position to impose a harmonised premium across all the States as suggested by the HMOs. What the NHIA Act provides for is that all State Social Health Insurance Agencies are to provide the same coverage to all the residents of the States but this may not be at the same insurance premium payments. 2. The NHIA Act in section 14 provides that it is mandatory for all residents of Nigeria to have social health insurance. It then goes on to state that a resident is allowed to procure a private health insurance plan provided such a person first participates in a State mandated social health insurance scheme – Section 14 (3). Also, the Act only allows HMOs to sell Supplementary or Complementary Private Health Insurance plans to persons who already have social health insurance plans. The implication of this is that residents of Lagos MUST have purchased an ILERA EKO health plan before purchasing supplementary or complementary health plans from private HMOs. Supplementary plans are top-up plans to the ILERA EKO health plan i.e. they contain additional healthcare benefits which are not available on the ILERA EKO health plan. A complementary plan on the other hand includes ILERA EKO benefits with additional healthcare benefits. The Agency in its letter of 5th July 2023 to HMOs brought this provision of the NHIA Act to the attention of the HMOs and requested that upon the expiration of their current policies, HMO clients would be expected to subscribe to the State Social Health Insurance Plan, ILERA EKO, as provided by the NHIA Act. However, with effect from 1st August 2023, new clients and those renewing their plans are expected to subscribe to the ILERA EKO plan. This certainly does not translate to an immediate transition of private health plans to the ILERA EKO plan as alleged by the HMOs. Neither does this imply the outsourcing of the Management of ILERA EKO plans to HMOs. While it is true that the Agency utilised the services of 13 HMOs that applied as Third Party Administrators (TPA) at the inception of the scheme, the services of eight HMOs have since been terminated due to unsatisfactory performance, while the Agency has since engaged its own staff to perform these functions. 3. The Lagos State Government is desirous of attaining Universal Health Coverage (UHC) and, therefore, aims to use the domestication of the NHIA Act as a veritable tool for achieving the objective. As a matter of fact, it is the NHIA Act that has further strengthened the provisions of the Lagos State Health Scheme (LSHS) Law enacted in May 2015 and which also made health insurance compulsory for all Lagos residents. In October 2021, upon approval by Governor Babajide Sanwo-Olu, the Agency commenced its regulatory functions with the primary objective of ensuring that all the over 25 million residents of Lagos State have Social health insurance coverage. To further show his commitment towards ensuring the attainment of UHC in the State, Mr. Governor issued an Executive Order in May 2023 for the domestication of the NHIA Act and the implementation of the LSHS Law. The Agency would like to put on record that it is saddled with a far greater responsibility of ensuring that over 25 million residents have access to healthcare services under health insurance than to chase after the less than 2 million clients of the private HMOs that already have health insurance. All the Agency requested from the HMOs was compliance with the provisions of the Law. The Agency informed the HMOs of the need to ensure that their private clients are captured on the State Social Health Insurance Scheme by registering them on the LSHS database for issuance of unique LSHS policy IDs. This will also prevent episodes of double counting should anyone move from one HMO to another. The HMOs were given up till 14th July 2023 to supply the details of their client(s) to LASHMA. This does not include those residents who are enrolled on the NHIS Formal Sector Program. 4. The Agency did not foreclose reaching a workable agreement with the HMOs as it gave them the opportunity to suggest options for a seamless transition in the domestication of the provisions of the NHIA Act in the State. At the time of writing this Rejoinder, the Agency has received responses from only 3 HMOs. It is, therefore, surprising that the publication stated that HMO clients were given an ultimatum to replace their plans with ILERA EKO health plan. The Lagos State Health Management Agency hereby states clearly that its actions are clearly within the provisions of the NHIA Act as it concerns the powers and responsibilities given to State Health Insurance Agencies, and the Operational Guidelines of the NHIA cannot supersede the extant provisions of the NHIA Act.
Consequently, Lagos State is at liberty to determine when it wants to domesticate the NHIA Act so far as it is in compliance with the provisions of the Act. Health is on the concurrent list of the constitution of the Federal Republic of Nigeria. 5. The Agency has already begun the process of engaging other stakeholders such as government agencies, public and private healthcare providers, employers in the organised private sector as well as the informal sector, professional associations, Labour Unions, religious and traditional leaders. The major objective of these engagements is to intimate them with the provisions of the NHIA Act thereby increasing public awareness and uptake of health insurance. 6. Finally, the Agency has a tacit responsibility to ensure that the over 25 million residents of Lagos State have access to quality healthcare services through the mandatory social health insurance scheme. The Agency, therefore, is willing to engage with all stakeholders in the health insurance sector in order to accomplish this onerous task and make it a win-win for everyone, especially the enrollees.
Signed
Dr. Emmanuella ZambaPermanent Secretary (LASHMA)30th July 2023
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