Am I my brother’s keeper? Why Universal Health Coverage begins with You

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Editor’s Note: This week’s Thought Leadership piece comes from Obinnia Abajue, CEO Hygeia HMO Limited, a Health Maintenance Organisation (HMO) based in Lagos. The article is a synopsis of Abajue’s riveting talk at the 2017 Future of Health Conference themed “The Business of Health,” where he argued the case for Health Insurance Coverage. He noted that one important way to ensure that your health is protected is to make sure that those around you have the health care and coverage they need. Watch his full talk in the embedded video. The article is edited and published with permission.

By Obinnia Abajue

Let me begin with a quick reminder of a Bible Story some of us were taught as children; the story of Cain and Abel, found in Genesis 4. The important part is v9:

Then the Lord said to Cain, “Where is Abel your brother?” He said, “I do not know. Am I my brother’s keeper?” Thereafter God cursed Cain for how he had treated Abel.

We are tempted to dismiss this as just another story, with no connection to real life but any keen observer of the Nigerian healthcare system may see a reflection of Cain’s question – “Am I my brother’s keeper? –   in the management of healthcare in the country. My goal today is to challenge us to take a bit more responsibility by changing our approach to the subject of healthcare coverage.

 

I will like to highlight three important facts about healthcare, which I believe will help us understand, from a general society viewpoint, why we need to change our approach to the subject of health coverage:

  • Healthcare is an interconnected system – No man is an island. If your neighbor is sick, it is only a matter of time before you become sick. If your community is sick, productivity becomes irrelevant. Then, imagine if a whole nation is sick… This is why there are communicable diseases and epidemics such as Ebola, Cholera, Meningitis and Hepatitis B. Healthcare is not only about curing diseases, it is a very large and complex value chain that begins from prevention or avoidance of disease.
  • Universal health care is about the survival of our race – As extreme as this may sound, it is true. It is our way of saying that we want to survive as a people and not become extinct.
  • The solution is to act and not wait for the government – The simplest way to help ourselves is to ensure that everyone has a plan to be able to pay for healthcare when needed and reduce out of pocket payment at time of need. This idea of needing to find a deposit to give the hospital for care has to go. And the ONLY way to get rid of it is to be able to provide a payment guarantee to hospitals. The easiest way to provide the payment guarantee is to adopt an insurance model i.e. we pool the funds and those that have a need can access care without having themselves or their families go. And because they are guaranteed payments, hospital owners will be willing to make investments, hire staff and improve service quality. Globally effective health systems are paid for either by public sector funding or by insurance premiums paid for by the people (private sector funding).
The Nigeria Health Watch team sensitizing locals in Akpegede Community, Benue state, on the importance of health insurance and why it is an important alternative to health payment at the point of service. Photo credit: Nigeria Health Watch

There is no rich-poor divide with healthcare

In August 2014, at the heart of West African Ebola crisis, Dr Stella Ameyo Adadevoh, was her brother’s keeper and helped prevent the spread of the virus in Lagos, at the expense of her own life. When Ebola hit the shores of Lagos, it came via the rich – the passenger was able to afford a flight to Lagos to escape his own Ebola-ravaged country, Liberia. In Lagos, he went to a private hospital, where the rich go. There, Dr. Adadevoh gave her life to see that the disease was contained even before the government stepped in.

You see, even though it is a social good, (defined as something that is of necessity to all in the society), the difference between healthcare and, power, roads and other utilities is: you can’t do a workaround with your health. You cannot get an alternative to blood or to oxygen for someone in need of it. You cannot delay or extend the four minutes that the human brain survives without oxygen; there are no fake spare parts, or repeatable contracts for the repair of the human body in need. A stroke does not discriminate by bank balances.

So, we must get the basics of healthcare right, with or without government support. We must do right to ensure that we survive as a community and a country. To do so, requires us to set up risk pooling systems that help to protect us by creating the capacity to pay for healthcare once you belong to the pool. That pool is our Health Insurance System.

This is a national crisis that can only be resolved by the people.

Many families have been impoverished by the cost of a major illness in the home – immediate or extended because there was no plan to manage the risk.

I know you have questions and concerns:

How do I know the Health Maintenance Organization (HMO) will pay when I need to use the plan?

  • The same way you know that when you buy something from anyone, it is what it says it is and it does what it says it will do.
  • When you pay for a service, you have the right to ask questions and demand that you get the service.

What can I do today?

  • Get involved. Buy a plan. Ask questions and improve your understanding of how it works.

I honestly don’t think I can afford to pay for health insurance

  • There is a plan for every price point. You don’t have to buy an expensive cover. But buy something.
  • Health inclusion is a financial opportunity – and there are a number of players considering financing health payments and micro-health insurance.

What can you do TODAY to make a difference and be your brother’s keeper?

Be your brother’s keeper, get a health insurance cover today for you and your family; and help someone else; your worker, dependent, relative… to pay for a plan.

Discussion3 Comments

  1. Obinnia’s narrative would have been more convincing if it was delivered by someone unconnected with a Nigerian HMO. The HMOs living up to expectation of many experts are the problem and obstacle to UHC in Nigeria. HMOs owe providers for many months and years in some cases thereby causing providers to stop treating enrollees, many of whom are already impoverished by lack of salaries for months in the first place. There is hardly any chance of having a functional enrolee friendly BHIS so long as HMOs remain as middle men gulping the riches from the pool. I need to be convinced otherwise!

    • Thank you for your comment, Joseph. You have a point. HMOs are largely unregulated and take laws unto themselves. A well-regulated health insurance sector where HMOs are accountable for their actions would ensure that service providers are paid for services rendered. Indeed, HMOs have a lot of work to do in building trust and confidence with Nigerians. However, the more Nigerians sign up, the stronger the voice that we have to shape the system.

  2. Onyiah Ikegwuonu Don.

    Financing healthcare is a major constraint in healthcare. Health insurance is a very important còmponent of healthcare financing. However, highly subsidized healthcare financing is very unlikely to sustain high quality healhcare on the longrun. This is due to the fact of profit motivation needed to promote more investment to improve the healthcare services. Lumping almost all healthcare services under a poorly funded provider financing kills incentive to improve healthcare services. Primary healthcare financing should be limited to the basic common health conditions that are prevalent while more major conditions can be financed on terms that provide incentive to the private healthcare investor. This will be beneficial to all concerned.

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