Nigeria’s health insurance sector should brace for consolidation, competition from foreign markets – Awosika
Total Health Trust (THT) a leading Health Maintenance Organisations in Nigeria and a subsidiary of the Liberty Group of South Africa, has been connecting its members to healthcare providers since its founding in 1998. THT won the HMO of the Year 2016 Award at the Nigeria Healthcare Excellence Awards. Ladi Awosika, a general medical practitioner and the chairman of the company, in this interview with BusinessDay’s Anthonia Obokoh and Omosomi Omomia, speaks on what needs to be done to deepen access to health insurance in Nigeria.
From your view as a leading player, give us an overview of how your company meets the challenges in the Health Insurance sector in terms of competition, industry structure, industry value (revenue/turnover) and volumes (of enrollees and health service providers)?
THT is unique because we go beyond just connecting our clients with healthcare to providing industry leadership through a combination of innovative product design, efficient operations and a focused customer service orientation. We deliver value added services as an integral component of our plans which cut across Maternal and Child care, Chronic Disease Management and other Wellness initiatives. Our experience, integrity and longevity in the HMO industry is what our partners have come to rely on and this has informed the versatility of the healthcare products we offer. These range from traditional managed care products to innovative fee for service products suited to corporate, SME and individual clients looking for comprehensive health cover and flexibility in accessing care.
In addition THT places value of conducting business within strict good corporate guidelines with strict focus on credibility and integrity. THT operates in a highly sensitive industry; as such it is imperative that we strive to maintain optimum levels of quality across our service areas.
We are very keen on ensuring that all our Providers meet the varied needs of our enrollees, thus we have steps in place to continually ensure that excellent service is delivered. Providers are our strategic partners in the HMO business so it is very important to us that we work hand in hand always to ensure that the enrollee’s needs are met.
At THT, we have a strong Provider Accreditation team made up of doctors and nurses who visit a hospital prior to them joining our network. This is part of a wider accreditation process that inculcates on-going periodic visitation of hospitals to review their processes and staff. All these are done to ensure that all hospitals on our network are capable of providing our enrollees with quality healthcare.
From over 70 health maintenance organisations in 2015, there are currently 60 HMOs spread across the country in 2017. How do you see this number evolving in the future?
Based on increasingly stringent operating requirements from the regulatory perspective, I envision a more consolidated industry with fewer but tried, trusted and stronger players with the capabilities required to drive the Universal Health Coverage agenda. Already, we see that some States which are rolling out mandatory health insurance are limiting the number of players for effectiveness. I therefore see an industry where consolidation through mergers and or acquisitions will occur as well as increasing dominance/competition from foreign/newer entrants with formidable health insurance administration expertise and technology from well-developed international markets
As a player in the Health Insurance Industry, what are the peculiar issues you encounter in successfully operating and providing quality healthcare to your enrollees, clients and customers?
The major challenge we face, just like other HMOs in Nigeria would be the low penetration of health insurance. This has been linked to the understanding of the populace about insurance in general of which health insurance is a part of. Culturally as well, the average Nigerian would not invest in health insurance as they believe this is an invitation to ill health.
Another challenge we face is in the issue of public health insurance. Nigeria is a federal state with different tiers of government maintaining reserved powers. While the federal government has moved to insure federal public servants, many States are yet to do same at the State level. It should be mandatory at all levels of government so that everybody can be captured under one umbrella.
The recession and the rising costs of healthcare is also a challenge that cannot be ignored.
Overall, what are your plans in the near future to take advantage of the gaps and opportunities in the Health Insurance sector in the Nigeria?
THT’s strategic objective is to continue to be the Number 1 preferred and trusted Health Insurance partner in Nigeria, contributing sustainable growth of the industry. Over the next few years, we are going to dedicate time and effort into ensuring that we maintain this position by providing the best possible service to our existing clients, while simultaneously attracting new clients with our innovative product offerings and excellent service delivery.
What is your assessment of the Health Insurance segment of the Health Industry today?
The health insurance industry is supposed to be pivotal in addressing the demand side of the poor health financing status of the country. The NHIS law enacted in 1999 was to provide regulation and direction towards attainment of Universal Health Coverage within 10 years after commencement in 2004. However poor implementation and professional leadership coupled with lack of political will and direction in our supposed federal system have stifled the attainment of the mission and vision of the industry. The important element of mandate for every Nigerian to belong to a prepaid health scheme (private or public) has unfortunately not garnered the necessary political will.
The health insurance industry has the capacity and human resources to scale up to expand the scope and breath of coverage when that mandate becomes law. We are all aware that even with the mandate, we shall still be decades away from 100% universal coverage, however where there is political will, sustainable solutions will be forthcoming.
Health insurance practitioners have over the years been developing the knowledge base and operational capacity to scale up.
The NHIS has covered less than 5% of Nigeria’s population. What, in your opinion, are possible strategies and initiatives that can result in the expansion and growth of the Scheme in Nigeria?
The health Insurance Law should make it mandatory that all Nigerians contribute into pre-paid health schemes. At this time and by the nature of our country, we need several pools that shall be under the oversight of a capably led Regulator. Thus private and public, commercial and not-for-profit pools are all required to address the needs of all segments of the population. National, State and Local governments must be ready and willing to contribute into pools on behalf of the poor and less-privileged in society.
There is also a need enact a new Bill to mandate health insurance membership, a bill that transforms the NHIS into a full regulator with appointment of capable leadership with cognate financial and insurance management experience, a bill that separates the Contributed Funds from the regulator, ensure that Boards are properly constituted and empowered with knowledgeable patriots. There is also a need for proactive regulation such as obtains in PENCOM, NAICOM and NCC and properly regulated broker channel.
Overall, what are your plans in the near future to take advantage of the gaps and opportunities in the Health Insurance sector in the Nigeria?
The gaps and opportunities in the Health insurance sector present viable commercial attraction for deployment of sustainable solutions once the enabling operating environment as per the ambiguities in the governing laws are addressed. THT will scale up with the other practitioners in the industry. Proper progressive regulation is essential to grow the industry.
In regards to the supply chain and the formulation of business partnerships, how much of a local emphasis is there?
Most of our most strategic partnerships (providers and vendors) are with local businesses here in Nigeria. For one, all our Providers are grounded Nigerian businesses and we go to great lengths to grow and nurture these partnerships. With our clients however, we have a more diverse set as our products are favoured by multinational companies, local corporates and SMEs.