Stakeholders responses on health maintenance organizations participation in Nigeria’s national health insurance scheme

Abstract

National Health Insurance Scheme uses the services of Health Maintenance Organizations to run the scheme. This model of administering a national health insurance scheme is different from how so many other national health insurance programs are run in other parts of the world. The designing of the NHIS to include the participation of HMOs is presumed to be an important model that would facilitate easy access to health care and improve the quality of health service delivery to citizens of the country. HMOs participation in the NHIS is paradoxical because HMOs are known as for profit organizations while NHIS are known as non for profit organizations. If HMOs are to participate in the scheme without making adequate profits, how then would they become profitable enough to sustain and remain in business? To ensure that the scheme is properly implemented, HMOs would have to perform a number of tasks/functions that may eventually result in engaging in practices that would be harmful to the scheme. However, years after the NHIS was established in the country, HMOs still function as major implementing partners of the NHIS. To inquire more about this model of running the NHIS, an assessment of stakeholders’ perceptions on the possibility of and the challenges of this sort of partnership is necessary to ascertain its workability in order to infer into what the future of the scheme would be like. To achieve this research study, responses from stakeholders like the NHIS itself, the HMOs and the Health Care Providers were collected in a total of nine In-Depth Interview sessions. Data on HMOs participation in the national health programme were obtained from the respondents, transcribed and analyzed. The findings of this study showed that HMOs played very important roles in running the NHIS. It therefore recommends that this NHIS model be strengthened to achieve its goals.

Keywords: Health Care Provider, Health Maintenance Organization, health insurance