Health
HMO Harps On NHIS Enrollees Rights
The Medical Director,
United Healthcare, Dr Kolawole Owoka, has said that it was the responsibility of Health Maintenance Organisations (HMOs) to sensitise enrollees for the smooth running of health insurance programmes.
Speaking with journalists in Abuja last Friday, Owoka said that most enrollees to health insurance programmes lacked basic knowledge of their rights.
“With the role involves prompt payment to providers, ensuring good quality of healthcare services and liaising with all stakeholders involved to facilitate the smooth running of the scheme,” he said.
The National Health Insurance Scheme (NHIS) programmes was designed to cover public sector, including employees of federal, state and local governments, uniformed services, organised private sector, students of tertiary institutions and voluntary participants. Owoka, benefit packages in the NHIS are out-patient care including necessary consumables, maternity care for about four live births for every insured contributor in the formal sector.
He said “preventive cares including immunisation as regards national programme on immunisation, health education and family planning education, general consultation, specialist consultation are parts of benefit packages. The benefit also covers hospital care in a standard ward for a stay limited to cumulative 15 days per year, eye examination and care, excluding the provision of spectacles and contact lenses.
“Also minor surgeries and major surgeries asides the ones on the exclusion list are benefit of the scheme to an enrollee,” Owoka said.
The managing director stated that NHIS enrollees were entitled to hospitalisation in general wards only with the exclusion of meals.
However, he said the use of amenities in private wards and feeding would attract extra charges to the enrollees at the point of use.
Despite benefit packages from the scheme, Owoka stated that there were health conditions totally and partially excluded from insurance programmes.
“Occupational, industrial injuries, injuries from natural disaster, conflicts, epidemics, injuries from extreme sports like car racing, horse racing, Polo, mountaineering, boxing and wrestling, among other injuries are not captured in insurance programmes”, he stated.
“Let me also say that treatments of drug abuse, terminal diseases, transplant and cosmetic surgeries, high cost surgical procedure, hearing aids and associated appliances, chronic renal failure, congenital abnormalities, infertility management were excluded in the NHIS services.
“Partial exclusions can be for life saving emergency treatment requiring high technology investigations.
“In that case, the HMO would pay 20 per cent of the cost of treatment while the other 80 per cent will be paid for by the contributor or employee,” Owoka said.
He noted that there were cases when enrollees would require referrals from a primary to an advanced healthcare provider, adding that there were procedures to achieve such.
According to him, a referral line should be established; there should be a clinical basis for referral, a referral letter to accompany every case.
Owoka stated further that personal, medical details of the patient should be contained in the referral letter, an investigation carried out at a lower level of healthcare before sending to a higher level.
Two United States scientists who unraveled the human micro RNA have won the Nobel Prize in Physiology or Medicine 2024.
Victor Ambros and Gary Ruvkun won the coveted prize for their work on microRNA as their discoveries help explain how complex life emerged on earth and how the human body is made up of a wide variety of different tissues.
MicroRNAs influence how genes – the instructions for life – are controlled inside organisms, including humans.
Every cell in the human body contains the same raw genetic information, locked in our DNA.
However, despite starting with the identical genetic information, the cells of the human body are wildly different in form and function.
The electrical impulses of nerve cells are distinct from the rhythmic beating of heart cells. The metabolic powerhouse that is a liver cell is distinct to a kidney cell, which filters urea out of the blood.
The light-sensing abilities of cells in the retina are different in skillset to white blood cells that produce antibodies to fight infection.
So much variety can arise from the same starting material because of gene expression.
The US scientists were the first to discover microRNAs and how they exerted control on how genes are expressed differently in different tissues.
The medicine and physiology prize winners are selected by the Nobel Assembly of Sweden’s Karolinska Institute.
They said: “Their groundbreaking discovery revealed a completely new principle of gene regulation that turned out to be essential for multicellular organisms, including humans.
“It is now known that the human genome codes for over 1,000 microRNAs.”
The World Health Organisation (WHO) has begun acting to curb effects of antibiotic pollution.
The new guidance on wastewater and solid waste management for antibiotic manufacturing sheds light on this important but neglected challenge ahead of the United Nations General Assembly (UNGA) High-Level Meeting on antimicrobial resistance (AMR) taking place on 26 September 2024.
The emergence and spread of AMR caused by antibiotic pollution could undermine the effectiveness of antibiotics globally, including the medicines produced at the manufacturing sites responsible for the pollution.
Despite high antibiotic pollution levels being widely documented, the issue is largely unregulated and quality assurance criteria typically do not address environmental emissions. In addition, once distributed, there is a lack of information provided to consumers on how to dispose of antibiotics when they are not used, for example, when they expire or when a course is finished but there is still antibiotic left over.
“Pharmaceutical waste from antibiotic manufacturing can facilitate the emergence of new drug-resistant bacteria, which can spread globally and threaten our health. Controlling pollution from antibiotic production contributes to keeping these life-saving medicines effective for everyone,” said Dr Yukiko Nakatani, WHO Assistant Director-General for AMR ad interim.
Globally, there is a lack of accessible information on the environmental damage caused by manufacturing of medicines.
“The guidance provides an independent and impartial scientific basis for regulators, procurers, inspectors, and industry themselves to include robust antibiotic pollution control in their standards,” said Dr Maria Neira, Director, Department of Environment, Climate Change and Health, WHO. “Critically, the strong focus on transparency will equip buyers, investors and the general public to make decisions that account for manufacturers’ efforts to control antibiotic pollution.”
In a concerted effort to curb brain drain, the Kebbi State Government has harmonised medical doctors’ salaries to be at par with their colleagues in the federal government’s tertiary health facilities.
Kebbi State Commissioner for Health, Musa Inusa-Isma’il, disclosed this at the handing over of ambulances to the state-owned health facilities at the Ministry of Health in Birnin Kebbi yesterday.
Inusa Isma’il, according to a statement by Ahmed Idris, the Chief Press Secretary to the governor, said the essence of the harmonisation was to retain the existing medical doctors and attract more to the services of the state.
According to him, the doctors across the state had already started enjoying the new salaries from August 2024.
He said the release of the vehicles was in fulfilment of Governor Nasir Idris’ promise to uplift health care services in the state.
“His Excellency said I should inform you, the beneficiaries of this gesture, that the vehicle should be strictly used for the intended purpose. It should not be used for anything else.
“If there is no referral case, each of the vehicles must be parked at the hospital by 6 pm. The governor said you should warn your drivers against reckless driving as well as violating the instructions.
“We should also do everything possible to reciprocate the gesture by working according to the terms and conditions attached,” he advised.
The benefiting health facilities included Sir Yahaya Memorial Hospital, Birnin Kebbi; State Teaching Hospital, Kalgo; General Hospital, Argungu; General Hospital, Yauri; General Hospital, Zuru; and General Hospital, Bunza.
In his speech, the permanent secretary of the ministry, Dr Shehu Koko, recalled that the ambulances were handed over to the ministry last Friday by the governor for the onward handover to the benefiting hospitals.
He observed that the ambulances would go a long way in improving the referral system in the state, adding that delays in reaching the secondary and tertiary facilities would be eliminated.
The permanent secretary attributed the high rate of maternal mortality in the country to delays in getting to the health facilities for proper medical care.
“We believe with the provision of these ambulances, part of the gaps we have in our referral system will be addressed, whereby patients who require secondary healthcare could be easily transported to secondary and tertiary health centres, where they can get such help,” he said.
In a goodwill message, Commissioner for Information and Culture Alhaji Yakubu Ahmed expressed gratitude to the governor for the support he has given to the ministry to excel.
While advising the beneficiaries to use the vehicles judiciously, the commissioner advised that services and maintenance of the vehicles must be prompt to derive the maximum benefits from the vehicles.
The commissioner also highlighted some achievements recorded by the government in the last year, including beautification of the state capital, completion of a multimillion-naira ultramodern state secretariat, road construction, construction and renovation of classrooms and upgrading of some health facilities, among others.