Cries over alleged exploitation of patients that are not enrolled on the National Health Insurance Scheme (NHIS) scheme by private hospitals is increasing across the country. Not only do the hospitals offer health care services at very high costs, they also give preferential treatment to beneficiaries of the scheme, especially through special units which make access to doctors and medical attention easier for them but difficult for the non-NHIS patients.
Daily Trust examines the trend against the backdrop of aggrieved patients’ experiences and plights.
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Salisu Ibrahim, a private school teacher in Kaduna State, who is not on any health insurance scheme said the private hospital he always attended charged as high as N1,800, N2,000 and above for malaria test because he was not on the NHIS.
“Just last week, I was charged N5,000 for malaria treatment at the hospital. Some of the prescribed drugs are also expensive and the hospital always insists people buy from them,” he said.
Our correspondent gathered that while pregnant women pay less than N10,000 for delivery in government hospitals in Kaduna, private hospitals charge between N70,000 and N100,000.
“Caesarian section in a private hospital is between N200,000 and N250,000,” said Halima Isa who was delivered of a baby recently in a private hospital.
Aliyu Mohammad who goes to both public and private hospitals in Kaduna said he was not informed about the NHIS and did not know how to get enrolled.
In Plateau State, those who are not enrolled with the NHIS said medical charges varied, depending on the hospital. Shittu Ibrahim, who has just recovered from malaria but not covered by the NHIS said he was charged N2,500 for consultation and drugs, excluding the charge for the test.
Aisha Musa, whose child suffered from malaria and being covered by the NHIS said: “When you are covered by the scheme, the charge is not much. You can only be charged 10 percent of the charge for the entire treatment. So, if your medical expense is N5,000, you would pay N500, which is 10 percent of the medical expenses. Besides, the test is always free for those covered by the scheme.”
Adda’u Usani Magaji, whose family is under the NHIS explained that when he took his wife to a private hospital for delivery, he paid N550 when she was discharged. However, Ali Mohammed said he spent N60,000 during his wife’s delivery because he is not on the NHIS scheme.
Dan Sotho, who is also not on the NHIS scheme, said to see a doctor in a private hospital in Abuja for consultation cost him N10, 000 and 20, 000. He added that he usually spent thousands of naira for consultation, tests and drugs.
“They would even insist that you must buy drugs from their hospital pharmacy after doctor’s prescriptions. Sometimes, it costs three times the amount you can get them at pharmacies outside the hospital,” he lamented.
Joseph Wantu is one among many people in Benue State who goes to private hospitals regularly on his bills because he is a non-NHIS- enrollee.
“I don’t have a choice. They are more efficient than some public hospitals which are mere consulting centres. I don’t care about the bills inasmuch as I get the quality of care I need. But the huge bills are quite worrisome. However, I try as much as possible to cope with the excruciating cost of getting the adequate medical attention that I deserve,” he said.
For Scholarstica Hir, the exploitation of non-NHIS-accredited patients by private hospitals remains a nightmare unless government steps in urgently to reverse the trend.
“Private hospitals charges are high. Due to incessant strikes in government hospitals, we are left with the only option of patronising private hospitals and since we are not enrolled, they make us to cough out huge sums of money as hospital bills. I think government should find a way to ensure that all Nigerians are enrolled,” she added.
Out of pocket payment for health care in Lagos has caused untold hardship for many residents. This is further worsened by the huge amounts of money they are made to pay for healthcare at private hospitals.
Many borrow to pay hospital bills, while others resort to soliciting for financial assistance from family members, their religious organizations as well as the social media to pay for their health bills.
Mrs Munirah Anas, a fashion designer, said she spent a lot of money at two different private hospitals for her child’s medical care recently.
She said: “My child fell ill and it got to an extent that we thought we might lose him. So, we took him to the nearest private hospital in Mafoluku. We were told he had a serious infection and we were on admission for three days. After spending N55,000, we had to leave be his health did not improve. Then we took him to another hospital where he got well. It wasn’t easy for us to pay the bill. It is because we are not on any health insurance scheme.”
In Kano State, there are two operational health insurance schemes—the National Health Insurance Scheme (NHIS) and the Kano State Contributory Health Scheme – being anchored by the Kano State Contributory Healthcare Management Agency (KSCHMA).
The KSCHMA was a product of a bill signed into law in 2016 with the overall goal of ensuring all residents of the state have access to quality and affordable healthcare services with financial and social risk protection.
However, investigations revealed that non-NHIS patients in both public and private hospitals face both discrimination in service provision and exploitation.
It was also gathered that many private hospitals have special units dedicated to NHIS & KSCHMA enrollees, while the non-accredited clients are left to suffer longer processes in hospitals before they can access medical care.
They also render differential services to other clients, a situation the former termed as discriminative to them and preferential to the health insurance enrollees.
Salisu Musa, a retired civil servant, said he took his brother to Aminu Kano Teaching Hospital (AKTH), a public hospital, and because he wasn’t an enrollee of NHIS, he was treated badly and had to take the patient to another facility.
A management staff of one of the hospitals who craved anonymity explained that due to various benefits attached to NHIS, some people often mistook it as rendering free services to enrollees.
“When NHIS enrollees pay for services, they pay a small amount of money based on the terms and conditions of their accreditation, while non-accredited clients pay in full. That is what is confusing other clients as preferential services to NHIS enrollees,” he said.
A non-NHIS enrollee at the Bako Memuna-Mercy, in Lafia, Nasarawa State, expressed concern over exorbitant charges by private hospitals in the state.
She said on January 7, 2021, she was admitted for one day at a private hospital in Lafia and made to pay N15,000 just for one dose of injection and a drip. She said whenever she fell sick, she was always worried about how to cope with the high cost of treatment. She called on the federal government to ensure patients in the informal sector enrolled in the NHIS.
Findings by our correspondents indicate that Nigerians struggle with out of pocket payments for healthcare, with an estimation that Nigeria records about 70 per cent out of pocket expenditure for healthcare.
This, experts say, does not augur well for the country’s health care system as it keeps people in poverty and slows efforts towards attainment of Universal Health Coverage (UHC) which means ensuring that people have access to quality health care services without suffering financial hardships.
The Executive Secretary of the NHIS, Prof. Mohammed Nasir Sambo, has said that only a total of 12 million Nigerians are covered by both the national and state health insurance schemes.
“The coverage under health insurance involves summation of coverage between the NHIS and the state health insurance agencies. As of the last count, we have been able to cover 12 million people in Nigeria and the number is increasing,” Sambo stated this in an interview with Daily Trust on Sunday.
Only about five million Nigerians representing three percent of the population are covered by NHIS and they are mostly from the formal sector, particularly federal civil servants.
Private hospitals not exploiting non-NHIS enrolees – AGPMPN
However, the National President of the Association of General and Private Medical Practitioners of Nigeria (AGPMPN), Dr Iyke Odo, said it was not true that private hospitals exploit non-NHIS enrolled patients or give preferential treatment to patients on state or national health insurance schemes.
He noted that many doctors were not happy with the way health insurance was being operated at the national level and across the states.
Odo said the NHIS paid N750 capitation per person in a month (the amount of money paid to cover treatment of a patient in a hospital per month ), noting that some hospitals may have only 10 enrollees, with some patients not turning up at all or coming even as much as four times per month.
He said the situation was even worse as some states’ capitation could be as low as N350 or N280 per patient.
He added that the trend did not augur well in the present Nigerian economy as it leaves the doctor stranded “because by the time two or three patients come, the money is finished.’’
He said Nigerians complained that private hospitals charged too much money but failed to take into cognizance the current economic situation and the plights of doctors and the hospitals.
He added that the country would only view private hospitals as business men and expected them to perform like social services providers.
“They don’t give us concession as it is done in most parts of the world. In other climes, ambulance has a special rate for diesel. There is also a special rate for power in hospitals as it is usually the lowest. But in Nigeria, we pay the same rate as oil companies and hotels. So, the society we belong to does not protect us,” Odo said.
“Indeed, in the register, we are defined as social services providers because of the humanitarian component of our work. Business men will not give you spare parts without money, but when you rush a dying patient to the hospital or a woman with obstructive labour, money or no money, the doctor is already working and everything he uses is bought with money, whether a pair of gloves, light, water or even biro. But no one thinks in these terms,” he said.
He added that it was baffling that Nigerians were okay with the cost of food, power, fuel and other services going up but wanted medical services to keep going down.
Odo said many hospitals were shutting down because they could not pay their workers and other running costs.
“Three years ago for example, we bought a pack of face masks for less than N700, but how much is it now? Syringes that we used to buy at N1,500 now cost N5,500. Also, ordinary gloves that used to go for N350, is now N1,700. The costs of drugs have gone up.
“The average Nigerian is unfair to doctors because he understands and is okay with the cost of things rising but wants the cost of medical bills to be going down. He has no problem that things are tough. Dollar has gone up. The cost of a basin of garri has increased from N2,000 to N3,000. The cost of two kilos of beef has increased. The cost of buying spare parts for automobiles has increased. But everybody wants medical bills to be going down. Where does that happen?” he said.
Blame government, not private hospitals
Dr Odo said it was important for Nigerians to be fair to private hospitals because they were not getting anything free from government, including loans.
He said the situation was different from public hospitals such as teaching hospitals that have allocations and doctors earn salaries, whether they work or not and have money for maintenance and others.
“Many Nigerians don’t treat their doctors fairly or consider us the way we should be considered. They see us as people who should keep giving free services. Yet, we don’t get anything free from government. Why should medical services be cheap in this era when even ordinary pure water is not free,” he added.
He said there was need to educate Nigerians to be more compassionate, understanding and more patient with the healthcare delivery system, adding that it was not the fault of Nigerian doctors that the health system is the way it is now.
He added that if government had lived up to expectation and shown a great leadership, 17 years after establishing NHIS, the country would have had a working health insurance that could be functional and trusted.
“You cannot blame the doctor in his consulting room for the failure of health insurance in the country. If it is working well and doctors are being paid well and encouraged, no Nigerian will be expected to pay for his medical treatment. Go to Rwanda, a small and poor Africa country but rich by the rule of law, good leadership and accountability, no one pays medical bill because everyone is covered,” Odo said.
He added that Nigerians should be grateful to the few doctors who had chosen to remain in the profession to support the health system because many are leaving the country for greater pastures.
FG should ensure more Nigerians are on NHIS – Expert
The Lagos state Chairman of the Association of General and Private Medical practitioners of Nigeria (AGPMPN), Dr Makinde Akinlemibola, explained that those who pay out of pocket pay more than those who pay through the NHIS due to a lot of factors.
He said: “The main reason for the difference in bills is that those enrolled on the NHIS are on health insurance. By implication, whether those individuals on the NHIS come to the hospital or not, their HMO would pay for them.
“There is a certain amount they pay every month regardless of whether they come for health care or not. When that happens, it will cover or compensate for when they don’t come. It is the collective payment of everyone that compensates for when an individual eventually shows up at the hospital and they pay very minimally since they pay every month.”
“Meanwhile, individuals without any health insurance will be charged according to the market rate. Those not on NHIS have more bills because they will have to pay registration and consultation fees as well as for drugs. Those on NHIS on the other hand do not have to pay for registration and consultation,” Akinlemibola added.
While citing an instance, he noted that individuals on car insurance pay less or nothing anytime their car gets damaged compared to those who have to pay out of pocket every time something happens to their vehicle.
He urged the federal government to ensure more Nigerians are on the NHIS and be guaranteed access to affordable health care when they need it.
By: Ojoma Akor (Abuja), Ibrahim Musa Giginyu (Kano) Hope Abah Emmanuel (Makurdi), Mohammed I. Yaba (Kaduna), Ado Abubakar Musa (Jos), Umar Muhammed ( Lafia) & Risikat Ramoni (Lagos)