Quality, affordable healthcare are objectives of Lagos state – Jide

The Lagos State Health Scheme Bill w signed into law in May, 2015 is a compulsory health insurance bill established by the enabling law of the state to ensure all residents of the state have access to affordable and quality healthcare. JIDE IDRIS, commissioner for health tells BusinessDay’s ANTHONIA OBOKOH that through this scheme, people living in Lagos can be protected from financial distress resulting from huge medical bills. Excerpts:

What is Lagos health insurance scheme all about?

Lagos health insurance is a healthcare financing scheme for the state; it is a way of mobilising fund for the sector, look at the sources of funds and how you channel the funds to do what you want to do. The sector is very huge and resource demanding. The law created a fund that is the insurance fund; it is just a pool of fund to which contributions are made. Every residence of Lagos is expected to contribute something into this fund by law. The state government will contribute its own bit into the fund in terms of equity fund, local government too will contribute, philanthropist who wants to support or anyone who is willing can contribute. And if things go right at the National level, we also stand to benefit from some contributions based on their law the National Health Act.

How is Lagos state planning to achieve this feat?

We are achieving this feat by creating a pool of funds which will be managed by the agency and the fund is used to pay for services provided by accredited providers and because people are contributing, they have a choice of who their provider will be. They can choose from any of the facilities either from the public or private. If you are not happy with any provider, you have liberty to make complains to the agency and if your complaint is genuine and well investigated, you are free to change your provider. For those people who are poor and cannot genuinely afford the cost of care, the state government will take care of it. That is why under the law, 1% of the consolidated revenue will go into that fund every year to take care of the poor and the vulnerable. But we need to determine who is poor because once people feel the money is there, everybody becomes poor.

Why the slow pace of implementation?

We are not starting the scheme 100 per cent complete because we cannot do that in one vessel; people need to understand the scheme and be explained to. But it is going to be a gradual process, as people see it progress, more people will enroll. So that is where we are.

But the key thing again is that, when we were doing the actuarial studies, one of the major challenges is that we do not have data in this environment. It is not the problem of Lagos state; it is the problem of the country. We thought of sourcing data from the national level, so that we do not have delay, but we realized they do not have and that was part of time wastage for us. So we have to start from the scratch. So when we are starting, it was not perfect because of the dearth of data. But we took a decision that we must warehouse our data, hold our data that is why we are deploying a robust ICT system which is going to link the enrollees, the providers and the Health Maintenance Organisation (HMOs) we are going to use. The information will collect which include demographic, financial and medical history will be analysed to plan, so it is very essential we get the ICT platform right. So what we are also doing is that we are talking to different stakeholders but it is a continuous thing and we are also engaging the media through media briefs. The HMOs we are using, contrary to what is happening at the national level, has been well with us because they have the institution and the structure although they needs to be monitored and controlled, We have shortlisted about 7 to start with after the advertisement and they will be part of the enrollment process because we are going to assign them to different local government.

Is the scheme mandatory for all Lagos residents?

Unlike the federal level, it is mandatory and compulsory for every resident of Lagos state by law, everybody must contribute. For those on the NHIS scheme, we cannot force them to stop, it will create unnecessary problem, and our focus is on those who do not have at all. In Lagos state, for civil servant, the government takes care of 75% contribution for the staff while the staff takes care of the remaining 25%.

How is Lagos state government going to address the issue of easy and quality access to care for enrollees on the scheme?

If you look at the totality whether in primary care, secondary care, tertiary care owned by the government, I do not think they are up to four hundred. And in these state,  if you look at all the private practitioner they are over four thousand. So, our focus is to effectively bring the two together so that the people will benefit, that is the issue of access. You also know that people have been complaining that if you go to the general hospitals, it is always over crowded, long queue waiting and at the end of the day some people feel they are not properly treated or issue of quackery, which is part of the fundamental problem within the system. What we are trying to do with this scheme is to reorder that system to address all those key problems.

How much are the different health plans for enrollee under the scheme?

After all the actuarial studies, government settles to 40,000 for a family of 6 annually which is for the basic plan, anybody who needs extra will pay for extra. If 70 per cent of the population is covered under this basic care plan, sickness will go down.

The idea is to maintain wellness of the people not merely to treat them; it is a total reorientation. We want to have these schemes so that people do not fall ill, giving them health education, specific protection, children who require immunization are easily provided, quality care for pregnant women so they can be monitored, delivery via normal or caesarean section. These are the little things that can be handled at the primary healthcare level. Lagos state wants to deal with the basic plan first and then primary health care is the picking point, we have two other plans. Private sector plan and formal sector plan. There are other people in the private sector who already have one plan or the other, but if you look at the totality they are less than 5 per cent of the population covered.

Are there plans for people especially those in the informal sector to pay in installments?

Yes we are flexible, we have plans but not in pieces, there are provisions for people to pay quarterly and monthly but we need to make sure they have means of paying to avoid cheating on others, so there is an open window you have once you enroll to start paying to forestall cheating, because if we break it down, it is 500 naira per person but you can only access care with providers in Lagos.