FRONT DESK OFFICERS TRAINING FOR HCFs by Hygiea HMO, Friday, December 5, 2014. ARCADE HOTEL, CBD, ABUJA

1. IMPLEMENTATION OF HEALTH INSURANCE
AND ENROLLEE EXPECTATION FROM HCFS
By
Dr. Yakubu Adole Agada-Amade,
AGM, SQA, NHIS
At the
FRONT DESK OFFICERS TRAINING FOR HCFs by Hygiea HMO
Friday 5th, December, 2014.
ARCADE HOTEL, CBD, ABUJA.

2. Outline
◦ Understanding healthcare financing
◦ What is health insurance
◦ Implementation of HI in Nigeria
◦ Organization of health service under the NHIS
◦ Rights and privileges of beneficiaries
◦ Expectations of enrollees
◦ Assessing humanity in a HCF
◦ The role of the HCF
◦ Obligations of HCF
◦ The role of front desk officers
◦ Challenges of implementation of HI – the front
desk of the HCF

3. Understanding HEALTHCARE FINANCING
◦ REVENUE MOBILISATION
◦ General taxation
◦ Health insurance
◦ Community financing
◦ Out-of-pocket
◦ External source
◦ RISK POOLING
◦ Unitary Risk Pool
◦ Integrated Risk Pools
◦ Fragmented Risk Pools
◦ Private Insurance
◦ Out-Of-Pocket Payments
◦ RESOURCE ALLOCATION
◦ Public administrations
◦ Non-governmental organizations
◦ Not-for-profit institutions
◦ Possibly, for-profit institution

4. What Is HEALTH INSURANCE
◦ Health insurance is a type
of insurance coverage that covers the
cost of an insured individual's medical
and surgical expenses.
◦ Mainly
◦ Social
◦ Private
◦ Also
◦ Community Health Insurance

5. Implementation of HI IN NIGERIA
BEFORE
◦ SHI
◦ Formal sector
◦ Public Sector
◦ TISHIP
◦ VCSHIP
◦ Organized private sector
◦ Informal sector
◦ CBSHIP
◦ Prison Inmate
◦ CUFSHIP
◦ Others (MCH, Diaspora etc)
◦ PHI
NOW
◦ TISHIP
◦ PPPSHIP
◦ FORMAL SECTOR
◦ CBSHIP
◦ VCSHIP
◦ UMCHP – Unified Maternal and Child Health Programme
◦ PHI

6. Organization of HEALTH SERVICE under the NHIS
◦ Healthcare services to be provided through a three level of service arrangement;
◦ Primary Healthcare Facilities
◦ Entry point and point of first contact of individuals with the HCF
◦ Gatekeepers to the scheme
◦ Provide preventive, curative and rehabilitative services
◦ Secondary Healthcare Facilities:
◦ Offer specialized services to patients referred from the PHCF through the HMOs.
◦ Occasionally, particularly in cases of emergencies, direct referrals without recourse to the
HMOs can be made.
◦ However, the HMOs must be notified immediately after.
◦ Tertiary Healthcare Services:
◦ highly specialized services based on referral from the secondary care level through the
HMOs.

7. ANYONE
Listening?

8. Rights and privileges of BENEFICIARIES
◦ Freely choose his/her NHIS accredited
PHCF
◦ Change PHCF after six (6) months with
the present PHCF.
◦ Access care once the name is on the
current NHIS enrollee register after proper
identification.
◦ Treatment at the nearest NHIS accredited
HCF on emergency.
◦ Add or remove dependant(s) subject to
approval by NHIS.
◦ Add extra dependant(s) on payment of
a fee.
◦ Be treated fairly without discrimination

9. Expectations of ENROLLEES
Simple
◦ Be treated fairly
◦ Be treated devoid of discrimination
◦ Be given due respect
Healthcare evaluation
Equity Efficiency
Humanity
Cost-
effectiveness

10. Assessing HUMANITY IN A HCF
◦ The quality of being civil, courteous or
obliging to others
◦ The principle that human beings have
free will and the right to make choices
about their actions and about what
happens to them
◦ Four dimensions of humanity
◦ Autonomy;
◦ Dignity
◦ Beneficence
◦ Non-maleficence
Autonomy Dignity Beneficence Non-
maleficence
Human
beings have
free will and
the right to
make
choices
about what
happens to
them
Human
beings are
worthy of
respect and
have the
right to be
treated with
courtesy
and with
consideratio
n for their
feelings
Principle of
striving to do
good
The principle
of avoiding
harm

11. The Role of the HCF
◦ Accreditation with NHIS
◦ Provide services as agreed with HMOs in the
benefit package
◦ Comply with NHIS Operational
Guidelines
◦ Sign contract with NHIS through HMOs
◦ Ensure enrollees satisfaction
◦ Provide returns on utilization of services and
other data to NHIS through HMOs
◦ Report any complaints to HMOs and NHIS.
◦ Limit delivery of services to level of
accreditation.
- NHIS Op Gd (2012)

12. Obligations of HCF
◦ Providing the NHIS with
◦ Names of serving health professionals and their
qualifications (doctors, nurses, pharmacists, etc)
◦ hours of duty coverage
◦ Details of equipment available for medical care;
◦ Ensuring that every beneficiary who visits the
facility for care is attended to with utmost
care, skill and prompt attention.
◦ Provide service to duly identified enrollee at all
times using the current NHIS enrollee register from
HMO/NHIS website
◦ All PHCF must have facilities for ante-natal,
delivery and post-natal care.
◦ NHIS Op Gd (2012)

13. The role of FRONT DESK OFFICERS
◦ A front desk receptionist serves as the face of the
organization.
◦ The first, and the sometimes only person whom the patient
meet.
◦ Largely responsible for the first impression people have about
an organization.
◦ Although an entry-level role, s/he needs a lot of skill to perform
the many tasks.
◦ Must be both excellent communicator and strong
administrator.
◦ Must comfortably interact with individuals of all professional
levels.
◦ Proper training for this role is essential, as well as clearly
outlining what is expected of the employee throughout her
workday.

14. Challenges of implementation of HI – the
front desk of the HCF
◦ Hostile desk office
◦ Combining front desk office and
medical records in a busy hospital
◦ Denial of service
◦ Name not on register
◦ No current list
◦ Failure to understand HI
◦ Failure to appreciate the importance
of HI
◦ Poorly trained front desk officer