The Managing Director, Defence Health Maintenance Ltd. (DHML), retired Rear Adm. Bayo Afolayan, has cautioned military healthcare providers against treating illegal enrollees under the National Health Insurance Scheme (NHIS).
Afolayan issued the warning on Wednesday in Abuja at a stakeholders’ meeting with military secondary healthcare providers titled “Strengthening Health Insurance in the Armed Forces.”
DHML is the Health Maintenance Organisations (HMO) that provides healthcare for military personnel under the NHIS of the federal government.
Afolayan issued an ultimatum to healthcare providers to open family medical files for all NHIS enrollees and their dependents before April 2022.
The managing director said the aim of the directive was to curb abuse of the health insurance system, which could lead to the total collapse of the entire system if not checked.
He said any institution without a mechanism for introspection was inviting failure as reviews allowed quick identification of flaws in order not to destroy the establishment.
Afolayan said the military HMO system, which was the best in the country, was large and complex and that the health insurance had come to stay.
He said to sustain health insurance in the military, there was a need to remind stakeholders of the tenets of the HMO insurance system, which had been adopted by the armed forces.
According to him, the system operates on accurate data of eligible enrollees, fidelity in claims systems, and prompt disbursement of funds by HMOs.
“All of us here are the main elements of the military healthcare delivery establishment, our collaborative efforts are at the heart of healthcare delivery to serving and retired personnel, their families, and dependents.
“One of the major mechanisms that enable HMO-based insurance is, accurate capture of eligible enrollees because capitation is calculated based on the number of enrollees.
“Where the system is abused and ineligible persons are registered, the result is the failure of the system as these illegal entries who are capitated do not contribute anything to the system they are benefiting from.
“Healthcare providers must scrupulously ensure that only eligible persons access to care in the scheme,” said Afolayan.
He said they must resist the temptation of registering overaged children, added wives, friends, parents, extra children to access care under the capitation element of the scheme.
“Such practices are not only illegal but can lead to the collapse of the HMO scheme.
“Consequently, it is now mandatory that military healthcare providers open family medical report files for all enrollees and their dependents with proof of registration.
“This should commence immediately as persons not captured in the family files will not be able to access care under the scheme as from April 1, 2022,” Afolayan warned.
The Acting Medical Director, Medical Services, Nigerian Navy, Commodore Ibrahim Nurudeen, described healthcare services for personnel as very good.
He acknowledged that there were some challenges, especially in the area where the NHIS Act made some exclusions that prevented personnel from accessing some high-level medical services.
He appealed to the DHML to make a presentation to the NHIS so that the Act would be reviewed.
Also, the Chief, Medical Services, Nigerian Air Force (NAF), Air Commodore Olabode Babalola, said NAF had keyed into the HMO insurance system approved by the military.
He said NAF executes all the programmes of the scheme in line with the rules and that the force participated in the primary, secondary and tertiary healthcare, which had been highly helpful to personnel.
He said the system was doing so well but there were room for improvement, especially operational injuries and gunshot wounds, and cardiovascular surgeries were not covered by the NHIS.
Babalola called for the amendment of the NHIS Act to allow for the treatment of gunshot injuries to better serve the personnel of the force.
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