Ambode and Lagos health insurance
The plan by the Lagos State government to go into health insurance is perhaps the best legacy Governor Akinwumi Ambode will leave. Ambode has never left anyone in doubt he has the people of Lagos in his mind always. Health is important. In the United States of America the most contested issue now is the health bill. The Donald Trump government is looking for a way to overturn Obamacare left by Barack Obama. It is all about how health insurance can work best for all concerned in that country. So it is in Nigeria where Lagos is planning to become the first state government that will go into health insurance in the Lagos State Health Scheme.
The benefits of a successful health insurance are innumerable. For one it will improve access to health to Lagosians, and lead to improved healthcare. It will allow secondary and tertiary health care institutions work best as they won’t be burdened by primary healthcare as we have presently. It will be perhaps the single most effective way of checking quackery. It will create more jobs and help the health sector to be more vibrant. And as always Lagos will be setting the pace for other states to emulate which will eventually lead to better health for all Nigerians.
But I am saddened that one of the criteria for providers is that hospitals must have been in existence for at least five years. (This applies too to laboratories and community pharmacies). That seems discriminatory to me. What this means is that a hospital that has been in existence for four years or less risks being annihilated because its clients will automatically move to where there is Lagos State health insurance, no two ways about it. This is not like a business contractor bidding for a job. If they do not get the contract, there are still other contracts. This is not like an application for employment where if you don’t meet the minimum years of experience there will be other jobs that you can apply for where you might meet their experience.
This is mandatory or compulsory health insurance! It is lobatan for such hospitals! It potentially means new hospitals can’t be opened! Or where will they get patients when the health insurance is compulsory? What keeps a hospital going is patients. Without patients the hospital can’t be viable. I reiterate this requirement will automatically kill those hospitals.
As someone enthused, it is like saying a lawyer who has worked in a chamber for 20 years and now decides to open his own won’t be allowed to have clients until his new chamber is 5 years! Or a professor of medicine who now decides to own a private hospital can’t treat Lagosians until his hospital is at least 5 years old!
The National Health Service Scheme (NHIS) or the Health Maintenance Organisations (HMOs) never require a 5-year minimum of existence before being part of them, nor do I know such a thing in any serious developed countries.
Hospitals are not like your regular businesses. They are humanitarian organisations. For any doctor to start a hospital, the Medical and Dental Council of Nigeria (MDCN) says that doctor must be 10 years and above post qualification. Any hospital that has been accredited by the Health Facility Monitoring and Accreditation Agency (HEFAMAA) should automatically be qualified. Or does the Lagos State government no longer trust this agency?
There should be a level playing field where any hospital based in Lagos and duly accredited by HEFAMAA can thrive. There is no hospital in Lagos, or Nigeria that cannot be the “best” or be world class if given the right support by government. Granted organisational experience is important, but it plays little role with hospitals. Or is the structure of the hospital now more important than the experience of the doctors or matrons and nurses? The hood does not make the monk. If it is ICT even those in the villages now have computers and internet access.
This is a country where many private hospitals are folding up, where doctors are unemployed or underemployed while Nigerians are sick. Today many Nigerian doctors are practising abroad because of the frustration. There are many hospitals in Lagos who are not known by Lagos State because they have chosen not to reconcile themselves with HEFAMAA. They will have no choice now but to submit themselves under government if being accredited by HEFAMAA is the single most important criterion to be a provider for Lagos State health insurance.
In developed countries where health insurance truly works, hospitals don’t look for clients. Enrollees are automatically sent to a hospital closest to them based on the capacity of that hospital. It is about serving a community. But here, one hospital amasses all the patients, and still wants more to the detriment of others. You see a patient living in Badagry and attending his hospital in Lekki where the waiting time of that hospital is 6 hours or more! While on his street there is a hospital that can equally serve him well if not better without wasting time. A proper health insurance scheme eliminates that.
In this economic recession the worst thing that can happen to a Nigerian is to have a policy that further impoverishes. I therefore call on the governor to look into this for fairness and justice.
• Dr. Ogundimu wrote from Epe, Lagos.
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