Health Maintenance Organisations, HMOs, are private corporations, usually managed by doctors and other medical practitioners, offering medical and health care to their client-members for a fixed rate or contribution. The HMO concept dates back to the 1900s when companies in Europe and the Americas entered into arrangements with medical institutions for prepaid medical services to their employees. The concept is a hybrid insurance and pre-need programme, and HMOs, figuratively, are engaged in life and death situations when they attend to the needs of their members.
Nigeria has since joined the growing list of countries with a law making the HMO concept an integral part of its national health system. In Nigeria today, whether or not you have a health plan, you need one. Every Nigerian does. But there are challenges ranging from low level awareness, poor education, inadequate information and lack of modern technology.
“One issue that we have identified within the Nigerian health system is the lack of information and awareness about health insurance,” said Mrs. Simbo Ukiri, MD/CEO, Avon HMO. “We believe that the benefits of health insurance and being part of a health insurance scheme, is one that most Nigerians do not know about. One of the first things we need to do to resolve this, is to be part of the wave that educates Nigerians and bring awareness to them that health insurance exists, works and delivers as promised. It is to let Nigerians know that health insurance has real, measurable benefits for every body and everyone should subscribe to it.”
Ukiri who was worried of the poor level of awareness, information, believes that with technology, universal coverage for all would become very attainable. There is need for engagement across all stakeholders in bringing value to their business and encouraging them to be viable and profitable businesses. This is key. The better approach to health plan is the coercive approach.
If left to people’s discretion, as a country and people we tend to believe the worst will never happen.
A typical Avon accredited health provider can be anywhere in the country, with hospital premises with a doctor in attendance for the whole day and a doctor within call overnight. “It should provide a well-equipped theatre, one or two specialists, an obstetrician and gynaecologist and especially what we call physicians who can attend to people with diabetes, hypertension, maternal and child healthcare and other chronic ailments.
“We want to have specialists within reach. The hospital will have internet, well-structured quality assurance tools in place that we can verify from time to time. We believe technology will achieve a key role in us attaining universal coverage. First step is to ensure that the system works, that it docs have the necessary skill and facilities. We have to be able to pay for the right services and make investments in the system. HMOs can make all the promises in the world to enrollees, but it is through the hospitals that they (enrollees) will experience our service.
“Our task in Avon is simple. We want to ensure that Nigerians from all walks of life have access to affordable and adequate health care, without facing financial obstacles when they need to attend to their health. That basically is what the Universal Health Coverage is all about, and that is what we are going to be working towards. We will ensure that there is a plan for everyone, no matter the social strata they belong to,’ she remarked.