When the Federal Government launched the National Health Insurance Scheme, some years back, its author did not probably factor in its capital intensive nature. Mr Tosin Awosika, managing director of Healthcare International, one of its practioners, said: “We have come to realize that what we are doing is a big business that requires much capital to enable us to carry out those things that we want to do.”
He adds “that is why we need to increase our capital base.”
In this piece, he explains why it is so.

The scheme
The National Health Insurance Scheme (NHIS) comprises two industries in one, health and insurance. So, my industry overlaps. To be honest with you, 2007 was a fairly good year. With all sense of modesty, the National Health Insurance Scheme, which kicked off about three years ago, has really moved on in leaps and bounds. And more people have been registered for the scheme lately. Many more people are accessing healthcare, which is the most important thing. When we started about a year and a half ago, many people were skeptical that it won’t work. It can’t be. How are we sure? The apathy that greeted the initial introduction of the scheme has since diminished.
And we now have quite many places where major surgeries had actually been attended to on the scheme, which largely has come to improve on the scheme itself.

Challenges
There are few hitches here and there. One of the major worries is that the regulatory authority is still struggling on the issue of identity cards, which is really what gives people access to the scheme. But quite a number of people, who have registered, because many Health Managenment Organisations (HMOs) have gone out to register for their enrollees, have been having problems with that .
I am glad to also report that in the last couple of months, the executive secretary of NHIS has actually given mandate that people must be registered so they are doing all they can. Expect that as soon as those slight hitches are taken care of, more people would access the scheme which will definitely boost its popularity.

Private sector
Now the next area is the organized private sector, which quite many of us had been marketing before now. Again, I must also confess that with the introduction of the National Health Insurance Scheme, we’ve also witnessed significant growth in the number of private sector enrolling particularly from among those companies that were hitherto sitting on the fence, whether to join the scheme or not.You know some people were weighing the scheme to know its financial implication, vis-a-vis their own healthcare plans.

They have come to realize the merits in NHIS and so many of them are now coming on board, joining various health plans being marketed by various HMOs. So that again has really shot up.
For example, on the last day of 2007, we won about three major accounts and they all want to start the following day, which was January 1. So that also say quite a lot about it. We believe that the scheme has come to stay to a very large extent.

Enlightenment
We know that we still need to do a lot of enlightenment on the scheme because in spite of all these positive developments that I have mentioned, I will also confess that in the course of the year too, there were still quite a number of people that you talked to and would still ask you: ‘what do you mean by Health Insurance Scheme? Or what are you doing?’ So, we expect to know that there is still quite a number of work that we need to do in this regard. Then, of course, we are still limiting most of our activities to the urban centres, the rural communities are still there. They are the ones that , more than anything else, require health insurance probably more than some of us in the urban centres. We have been to many rural communities in recent times and we found out that the nearest health facilities to most of them are of considerable distance away.

And that also means that there is still a lot of work to be done in that regard. In all, in as much as one will say that, yes, there has been a significant growth, I will say that there is still a lot, much work that still needs to be done in that regard.

Enrollees
Well, as regards the number or volume of enrolments in the public and private sector put together, I think we will probably have at best two million or 2.5 million enrollees in all. You will agree with me that’s barely one or two per cent of the entire population of the country. That was why I said that, of course, there is still much work to be done.

Of course, that takes me to your question about our prospect in the rural communities. And if you look at it from the point of view that there are not many industries in those localities, what model do we intend to adopt to accommodate the people there? The thing about the national health insurance scheme is that it is a social insurance scheme.

The private scheme is profit-oriented. By and large, the expectation of government is that at end of the day everybody is going to come under one scheme. Which will have some element of profit and ,of course, it will still have a social nature. The other side to it is that insurance , by its very nature and health insurance specifically , is also about pooling of resources. In insurance, there is a lot of subsidies. When you are looking at health insurance, subsidy comes from the fact that those in the urban centres who earn more are likely to subsidize the premiums for those in the communities. If you look at the whole concept of insurance, it is like everybody is supposed to contribute an equitable amount into the common fund. That equity is in form of many things.

Like now, when you look at the national scheme, it is supposed to be 15 per cent of income. Of course, 15 per cent of the salary of a Permanent Secretary is multiples of 15 per cent of the salary of a cleaner in the civil service.

Yet, the same amount of money is paid on their behalf to the hospitals. So, you understand that what is being deducted from the salary of the permanent secretary would already have taken care of quite a number of the cleaners. And then it goes down like that. We expect that the contributions of the urban centres of those in the formal sector, particularly in the organized private sector, would be considerable more than those in the communities.

However, I will be quick to point out one thing too. Those in the rural communities have the volume which is critical in insurance. I have just told you the number of enrollees in the organized private sector is just about 2.5 million. Now if I were to face one or two states looking at only those in the communities, I would be looking at about 10 million people or so.Even if I ask them to contribute a token of what those in the urban sector are going to be contributing, you will find out that the aggregate payment from the rural sector will be considerably higher than the aggregate payments of the urban centre. So, those are the things we are looking at.

Invariably, you find out that what they lack in financial power in the communities, they have in terms of volume and numbers.It is that number that is going to create the pool of resources which will enable the scheme to effectively take off there. The most important thing is what you want from the rural set-up. For most people, they just want access to care which those of us in the city also take for granted. What are the commonest ailments that you have around? These are the usual malaria, urinal tract infections, respiratory infections and things like that. They are mostly out patients. And most of these ailments can actually be nipped in the bud once they are taken care of particularly if you there is a private care centre there to handle most of these things.

I can tell you that access to care takes care of 70- 80 per cent of the treatment. It is not every sickness that requires drugs, it is not every sickness that requires hospitalization.Again, most illness don’t deteriorate or will not deteriorate to the level that you are going to require surgeries and all such expensive medical treatments.

But it is unfortunate that’s what is lacking. The other side to it, for instance, is that you are also looking at the rural communities.They don’t have water. I can assure you that if you look at WHO statistics, if you give people in the rural sector portable water, you have taken care of at least 60 per cent of their health needs. Because those are the things that disturb them the most. Most of them have typhoid, river blindness etc, which are conditions that arise from poor hygiene and poor drinking water. So, if for instance, you go ahead with provision of portable water , you will have nipped these common ailments in the bud.These are the things that we expect to do if we have the rural communities on the scheme.