NHIS’s capacity building for medical doctors By Adeleke Gbenga Normally whenever the National Health Insurance Scheme(NHIS) organizes workshops for its stake holders, the topic always borders on the usual health care services that are not adequate or that are not available at all. At time it always borders on the need to enlighten the enrollees most of whom who are yet to properly understand the nitty gritty of the scheme they have been operating for almost nine years. More often that not the NHIS’s usual workshop is also often about perennial conflict or misunderstanding between the NHIS accredited Health care providers and the enrollees on one hand and misunderstanding between the Health Maintenance organization and the Health Care providers on the other hand. However, this week NHIS’s workshop was a different ball game entirely for the first time in the life of the scheme. This week Wednesday’s workshop organized on 20th November at Kingstone Suites, Ilorin by the NHIS North central zone office, Ilorin borders on book keeping and accounting procedures. It was organized for the Medical Directors and Accountants of the NHIS accredited Health care facilities otherwise known as Health Care providers. In a simple term, the workshop was to enlighten the Chief Medical Directors or the proprietors of various hospitals and clinics in Kwara State approved by the NHIS to provide health care services for their NHIS customers i.e the enrollees about how to keep account or record of their transactions in their clinics. The essence of it is to enlighten them i.e medical directors on how to account at a glance for how much is going out of their clinics and how much is coming in, i.e how much their clinics i.e Health care facilities are generating in term of cash. It was a capacity building workshop to equip them with the fundamentals of book keeping and accounting procedures i.e how they keep record and management of the financial transaction between them and the enrollees on one hand and HMOs on the other hand. By this they will be able to know if they are progressing or retrogressing in business. This was about business side of the health care services. This means that health care services is a serious business. As far as the management of NHIS is concerned, many of their accredited clinics and hospitals were not good at business and management of their services. One thing is to be educated and trained as medical doctors and pharmacists, another is to know how to translate that knowledge and expertise into successful business. The NHIS’s management from its experience discovered that one of the challenges hampering the smooth operation of the scheme which might affect the 2015 universal coverage if not quickly corrected is poor record keeping by the NHIS accredited Health care facilities. For example whenever the NHIS team comes for the reconciliation of the account and book keeping at any of their accredited Health care facilities, it is discovered that more often than not, the accredited health care facilities always find it difficult to properly render good account on how they manage the NHIS’s fund. The truth of the matter is that NHIS’s management is often embarrassed that their doctors and pharmacists who should be good and effect managers of resources in the first place, to whose custody they entrust the NHIS’s fund often find it difficult to render good account of the management of this fund. Even whenever these Health care facilities are shortchanged by the HMOs who always look out for lapses or loopholes in the scheme’s operation to make excess profit, the health care facilities are not always in the proper picture because of their poor management of their accounts. This often result into conflicts, claims and counter claims that are affecting the smooth operation of the scheme. This was the reason the NHIS deemed it fit to organize the workshop. Most of the issues that came up for discussion at the workshop included; how the Health care facilities will manage the capitation they are paid by the NHIS through HMOs? What are the Health care facilities supposed to do whenever HMOs fail to send them the accurate number of the enrollees paid for by NHIS? These were reflected in the opening remarks of the NHIS’s North central zonal coordinator, Alhaji Attahiru A. Ibrahim who provided insight into the essence of the workshop. Two papers were presented on topics “Booking and proper Accounting procedures” by Alhaji Bashir Isah Ubandawaki. The second paper was presented by Mallam Ahmed N Zubair titled “Utilization of NHIS funds Towards The Delivery of Health Care services” using the Okene zonal hospital as a case study to throw more light on the paper. The first paper which was on “Book keeping and proper accounting procedures” was too technical to understand by the audience who do not have accounting background. But it was simplified by Mr. Bogunjoko Francis who stressed in his explanation that book keeping and accounting was necessary for the management of the capitanon for smooth running of the scheme. Since, according to him the transaction between the NHIS accredited Health Care facilities and enrollees involve financial relationship, it is in the interest of all the stakeholders, NHIS, health care facilities, HMOs and the enrollees to keep track of the money and how it is managed. “Our hospital directors need to know how to keep the record of the transaction between them and HMOs, NHIS and the enrollees. This is what is called book keeping. The essence of this is to equip them with capacity to be able to account at a glance for how much is going out of their clinics and how much is coming in i.e how much their health care facilities are generating for them. They must know if they are progressing or retrogressing. Because in this scheme, we need to account for how we manage money entrusted to us” he said. Speaking further, he said the financial document that contains all cash receipts and payments is called cash book. Entries in cash book are later posted into the ledger. The process involves collation, analysis, summary and recording of the financial transaction into a book of account called ledger. This is what is called booking keeping according to him. “Therefore the process of bookkeeping flows from collating financial transactions to analyzing, summarizing and finally recording such transaction until recording is done into a ledger account. The book keeping process can not be said to have been completed until it is properly recorded in to ledger book” he stressed. He also said that the use of debits and credits allows the HCFS to keep track of their transactions and manage their money stressing that whatever is done to one side of the cashbook must be done to the other side. He emphasized further that the two sides of the cash book equation e.g debits and credits must always be balanced. On the second paper which is “utilization of the NHIS funds towards the delivery of health care services” the presenter of the paper, Mallam Ahmed N. Zubair took the audience through the fundamentals or basics of the NHIS which included the origin of the scheme, its modus operandi, roles and responsibilities of health care facilities, beneficiaries, sources of funds, HMOs, services rendered to enrollees and a case study of the Okene hospital on how it has utilized the capitation. According to “NHIS is a complementary strategy to provide sustainable funding for the health system. It was established as corporate entity under Act Cap 42 LFN(2004) formerly Act 35 of 1999. It is a social Health security system in which the health care of employees in the formal sector is paid for from fund created by pooling the contribution of employees and employers. “This are earning related. For the public (federal) sector programme, the employer pays 3.25% while the employee pays 1.75%, representing 5% of the employee’s consolidated salary. For the private sector programme and other tiers of government, the employer pays 10% while the employee pays 5% representing 15% of the employee’s basic salary”. For the roles and responsibilities of Health care facilities, he said “These include securing appropriate accreditation with NHIS, provision of services as agreed with HMOs in the benefit package, need to comply with NHIS’s operational guidelines and others”. On the beneficiaries, this was what he said “This include employee, a spouse and four children below the age of 18 years, other dependants of the employee may be covered by additional contribution etc. On the source of fund, this was his views “capitation is the payment made to primary Health care providers by the HMOs on behalf of a contributor for services rendered by the Healthcare provider. This payment is made regularly and in advance irrespective of whether the enrollee utilizes the services or not. “Fee for service is payment made by HMOs to secondary/tertiary health care providers that render services on referrals from other accredited healthcare providers. Primary health care providers can also be paid on fees-for-service basis for emergency cases” he reiterated. Several questions were asked during the question and answer period to which the NHIS’s management provided answers.
Posted on: Thu, 21 Nov 2013 18:13:22 +0000
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