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Punch | Poor Awareness Hindering Health Insurance Development

By August 26, 2013 No Comments

In this interview with NIKE POPOOLA, the Chief Executive Officer, Avon Healthcare Limited, Mrs. Simbo Ukiri, speaks on the relevance of health insurance.

How does health insurance work?

I will compare health insurance with other forms of insurance. Comparing health and motor vehicle insurance for instance, people do comprehensive vehicle insurance, while others do third party. You insure your car against theft, fire and other things, but you pray they don’t happen. For some people, it doesn’t happen, and for others, it does. Health insurance is similar because you insure your health against a specified list of possible occurrences. One day, one or more of those things on that list will surely happen. You can’t possibly avoid it because from time to time you will fall ill. God forbid, accident may happen or not, but it is certain that nobody has a perfect health from the first day he is born till the last day that he dies. In health insurance, you know that those services will be required and will be used.

 How does insurance meet different health needs?

That is one level, but each person can actually choose within a wide variety of health insurance plans, and choose the one that is most suited to his own needs because we also have different kinds of health needs at different ages.

Health insurance makes sure that when you go to the hospital, you don’t have to pay from your pocket because ill health doesn’t give an advance warning. In addition to that, health insurance makes sure that if there is a need for any form of health service that you would normally not be able to afford, insurance will make sure that you don’t die because it is a system that spreads risk across many people.

Let’s say 100 people are insured against cancer, each one of them cannot afford cancer treatment, but by the time you look at the collective premium all the 100 people have paid over a period, that pool makes it possible for one, two or three people to have cancer treatment without any impact on their finances and without the fear of their inability to afford the treatment.

It is a system that gives the people access to higher and more expensive health care services that they would not have been able to have access to on their own. In addition, it is a system whereby people are able to access health care services when ill health comes without dipping their hands into their pockets. For a yearly premium, such needs are covered.

Does a person with health problems have to go for a test to have insurance cover?

That is called adverse selection in our industry because, really, health insurance, like all other kinds of insurance, is based on probability. That is why the value is in the pool that is created. The value is in when you have a mixture, some have and some don’t have. By the time people who know they have an illness buy a plan just to take care of the illness, you know it is no longer probability or insurance, it is a certainty. So, if someone already has it, it is not that the person cannot take out an health insurance policy, the person can still do that, but what most health insurance firms do is that pre-existing conditions like that must be disclosed because the cost of taking care of that condition will be built into the cost of the premium; this is because it is a certainty. The uncertainties are other ailments outside what a person already has. So, you can say this person has already been diagnosed with cancer; there is a premium that person will pay because there is a pre-existing condition that has been disclosed. Or, there are many ways insurance companies mitigate such cases. It is either that they won’t cover it for the first two years, and after two years on the plan, they begin to cover it or; if they are going to cover it from day one, they give a higher premium. There are many ways of looking at it, but it is something that needs to be disclosed at the point of buying the plan.

 What structure have you put in place to bridge the gaps in health insurance plans?

First, one needs to think of why we have not been able to cover more people. This would give one the idea on what structures to put in place to address the challenges. One of the challenges has been the lack of awareness and lack of enough investment in marketing activities to point out the benefits of health insurance. We will address this. We are going to work very closely with our regulator in changing the mindset of most Nigerians and pointing to them the valuable benefits of taking out health insurance plans. We don’t pray for it, but when the unexpected happens and there is a terminal disease or there is an accident, then what does one do without insurance?

What about those who are not covered by large corporate organisations?

Also, there is a large sector of Nigerians in the informal sector. Prior to now, most HMOs concentrated on the federal civil servants as well as the large corporate organisations. The reason for this is because they are easy to identify and reach, but what happens to the people outside this large coverage? That is where we come in and that is why we have positioned ourselves with the kind of distribution channels we are developing. We are also developing sales channels to be able to reach smaller companies, the self-employed and professionals, to reach them and make our products easily accessible to them. The matter is how easily can they access care if they need it? These are the major things we have taken into consideration before coming into the market. And, we believe that we have the right structure in place to enable anybody that wants it to have access to it.

 If a person with insurance cover gets ill where there is no registered hospital, what should he do?

What we advise is that you first call our centre. We have a 24/7 call centre, which all our enrolled members and clients have access to. At this call centre at any point in time, we have one or two medical professionals on duty. We can also reach our data base and advise on the nearest hospital to where that person is making the call from. But even if there is no hospital within our network where that person is making the call from, we can always tell the person a hospital nearby that may not even be on our network but where the person may pay personally. The assurance and comfort is that even if the person has to pay, that money will be refunded because that person has access to care that is covered by the health care policy he has with us.

 What is the maximum number of dependants a person can register under the National Health Insurance Scheme?

It is very free and open; you can register as many people as you want, even a family of six can register, more children, multiple wives, all of them can be registered under a health insurance plan. What may be relevant to say is about the price, a plan that has been planned for a family has a person, his spouse and four children under 18. So, additional subscription will come at a different price.

 Is health insurance expensive?

I can say definitely that taking a health insurance policy compared to not taking it is a lot cheaper. It is cheaper for us as a society, it is cheaper for us as individuals, it is also cheaper as a country trying to develop a robust and international standard health care system. At the end of the day, by the time you pay that annual premium, over time, no matter what happens to you, it is not expensive.

For instance, I have a colleague who told me that for six years, he and his wife were on this health insurance plan, and he started feeling bitter that he did not see the need for it because none of them had any terminal illness. All they had were minor illnesses; and meanwhile, they bought a really robust plan. But he saw the value in it when his wife became pregnant with twins and had complications and was on bed rest for almost four months.

His hospital bill doubled all the premiums he had paid for six years because at the end of it all, those children had to go into the incubator when they were born. One doesn’t pray for such, but one must know that as individuals, no one has perfect health from the day he is born till the day he dies.

 What can be done to make the NHIS grow?

I think right now, discussions are going on between the regulators, all HMOs and hospitals. Every key stakeholder that is part of this system is part of this discussion being spearheaded by the NHIS. The ambition is there with the NHIS, it is very strong, the passion is also there to fix this, so that it will not be seen that we as a country have not been able to achieve the same stride as our contemporaries are doing when it comes to health insurance coverage for the populace. I am very confident with the kind of discussion going on that in a year’s time, Nigeria will have a good story to tell.

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