Introduction to HMOS In Nigeria
HMOs in Nigeria are companies that are allowed to solely manage the provision of healthcare services via the health care facilities such as; hospitals, doctors, opticians and dentists that are accredited by the scheme. In simple terms, Health maintenance organizations acts as the middleman between the hospitals and companies that seek to provide health care for employees and their families. The HMOs offers quality health care and affordable health services to its customers or members. Most of the Health maintenance organizations in Nigeria are dedicated to providing Nigerians with quality medical services through their highly motivated personnel and health partners.
Health maintenance organizations are either publicly or privately incorporated entities that are registered by the NHIS to manage the provision of health care services through health care facilities accredited by the scheme. The HMOs work in coordination with the National health insurance scheme. However, the National health insurance Scheme has a duty of registering and keeping in-check the activities of the health maintenance organizations in Nigeria. It does this to ensure that the HMOs do not go below their expected standards. Whether the HMOs are private or public, the NHIS ensures that quality and less expensive health care services are being offered by the providers under the scheme.
A HMO plan varies with a person’s requirement. If you want a plan with lower premiums, or a plan without a deductible or requiring preventive care services; an HMO will provide you with a plan you are okay with. HMOs have different plans or policies which include: basic plan, premium plan and executive plan. With the premium plan, one can get capitation similar to a regular insurance. Characteristics of a capitation are as follows:
- The employees that are covered are in most cases confined to one or two hospitals at the time of coverage.
- For all the employees covered, their premium is paid periodically.
- Hospitals are paid in advance with an amount known as ‘’capitation’’ by the health maintenance organization irrespective of whether you use them or not.
- Hospitals will offer you services as long as they’re among the hospitals that you choose in your network.
- There are several classes of coverage with each comprising of its own benefits. For instance, a basic plan may have benefits that covers the following; admissions, ambulance services, prescribed medicines and dugs, minor surgeries, general out-patient and in-house specialist consultation, x-rays, laboratory and diagnostic tests.
HMOs in Nigeria have several features. These health providers have several networks through which health care services can be obtained. The HMOs could be offering an open access plan or a primary care physician plan also known as “gatekeeper”. For instance, if an HMO is using a PCP, the gatekeeper is responsible for organizing a patient’s referral, while the open programme allows patients to select any specialist in the network without a referral. HMOs also use reimbursement arrangement to encourage providers to be more cost conscious.