Chioma Umeha
Dr. Shola Akande is the Executive Secretary of Oyo
State Health Insurance Agency (OYSHIA). In this interview with CHIOMA UMEHA he
discusses the establishment of OYSHIA, Oyo State Government plan to use the
scheme to expand access to healthcare for citizens, especially to curb maternal
and child mortality, to achieve Universal Health Coverage (UHC) for citizens,
among others.
Establishment of Oyo State Health Insurance Agency
(OYSHIA)
Oyo State Health Insurance Agency (OYSHIA) was
inaugurated about 20 months ago and we have been able to enroll about 100,000
residents of Oyo State. Actually, the establishment of OYSHIA is backed by law,
which was signed by the Governor of Oyo State, Governor Abiola Ajimobi.
The law states that direct insurance in Oyo State
is compulsory for every residence to follow and so, today we have both formal
and informal workers enrolled in the scheme.
About 100,000 enrollees that have benefitted
immensely on this scheme and consequently, some people that have been delivered
even through caesarean section without additional sum from the premium they
paid.
Other medical interventions, which citizens
benefited from include appendicitis, orthopaedic, surgery, among others, all in
the last 18month that OYSHIA started operations. Not only that, through the
scheme, a lot of health facilities have been renovated, equipped and we have
constant supply of drugs to those facilities.
Not only that, through the facilities we engaged
about 35 doctors that are working in those health centres. In other words,
citizens in Oyo State have benefitted, various facilities have benefitted and
of course, health workers too have benefitted from the scheme because they now
have a better environment to practice their profession.
OYSHIA’s objective
The target of OYSHIA in the next six months is to
reach about 400 to 450,000 people which is about five per cent of the
population of Oyo State. For us to reach that particular target, we need the
cooperation of the media practitioners.
Advantages of health insurance
One of the major benefits of health insurance is
that it changes your health-seeking habit, making you to see your medical
doctors even when nothing is actually wrong with you. Not only that, it gives
you the opportunity to ask questions, it raises issues because you paid a
premium and that is crucial.
What makes us to talk about these
things is that healthcare is not curative alone; it is also preventive and
under OYSHIA, we are doing so much of prevention because that is the way
medicine is going all around the world. People are not just talking about care
any longer; they are focusing a lot on prevention. This is so because is
cheaper to prevent illnesses than to cure, even in health insurance. That is
how the money in those health facilities are protected so that we will be able
to take care of serious illnesses whenever they occur.
That is
why under health insurance as a provider, I talk to the enrollees to know about
prevention. I don’t want them to be sick. I don’t want them to be using the
money and my account will be growing fatter and fatter. However, one day one of
the enrollees will have a health problem. Although, the enrolee paid only
N8,000 premium, I have to treat that health challenge, the cost of which
amounts to about N400,000. That is the benefit of health insurance.
Challenge of existing health problems and
insurance
A major
problem facing OYSHIA from informal sector now is that a lot of people coming
into health insurance with existing health problems. People that are newly
enrolled come with diseases. After, they have gone to medical doctors and told
that they require a surgery which costs N50,000, that is when they pick up an
enrolment form to register in the health insurance. A practical example is a
female civil servant in Oyo State whose child was very ill; she took the child
to the hospital where the child was diagnosed. The treatment plan which will
require the transfusion of two pints of blood, will gulp N50,000. It was at
that point she came over to state her readiness to enrol in OYSHIA, but I
informed her that she was late in the plan to join.
Meaning of health insurance
Health
insurance is putting money aside when you are okay, not when you are ill. That
is one of the problems facing OYSHIA currently. Let me tell you how we are
solving that. If you as an enrollee has an existing health problem, we will not
take N8,000 from you as the premium. We will take N28,000 premium being the
cost of family plan from you. That, in a way would have pushed up our enrolment
and at the same time enable us attend to your own problem. This will be
applicable to you if you have an existing health problem. The moment that you
have an illness such as hypertension or diabetes before coming into the scheme,
it’s an existing problem.
If you
are coming into health insurance, we will tell you to state clearly if you have
any existing health condition while filling your form? We know that a lot of
people lie, but we will get to know thereafter. That is why I tell people that
when you are registering for insurance, state the truth; there is no big deal
in being a high blood pressure patient or being diabetic. Even, there is no big
deal about your status being HIV positive. This is so because some that have
been HIV positive for 20 years are still alive. If you lie and we find out
later, we will not avail you of treatment because ‘Ab Initio’ there was no
contract.
Method of premium payment
In health
insurance, we spend the money in advance. Health insurance is a circle; if
those things are not there, people cannot use those facilities. We have to make
sure that those things are there so that enrollees can choose. One of our
primary care centres (PHCs) has over N2 million in its account. That one can
conveniently pay its doctors.
Number of annual check-ups for an enrollee
You do a
medical check-up once every year. There are some tests that you cannot be doing
all the time especially basic tests; you have to be careful. You don’t want to
go to doctors all the time and be prickled to get your blood all the time. That
will expose you to some dangers as well and there are some tests that if you
have the figure now, that figure can last for the next three years. For
example, you don’t do cholesterol test all the time. My last cholesterol test
was last year; I know the value. I will wait for one year and go and do it
again.
For blood
sugar test, if you did once the next blood sugar test will be at the instance
of your doctor especially if your blood sugar was high at the first instance.
It’s not you that you will decide. That is one of the problems we are having
with enrollees. Enrollees go in and demand for specific drugs.
We have
patients calling doctors to say they have malaria without having undergone the
rapid diagnostic test.
Role of Information Communication Technology
If you
are doing an health insurance without an Information Communication Technology
(ICT), it will not work. It is the ICT that will ensure the first level of
transparency in the scheme.
