ASSESSING AND IMPROVING THE PERFORMANCE OF HEALTH MAINTENANCE ORGANIZATIONS IN THE NIGERIAN NATIONAL HEALTH INSURANCE SCHEME: THE HEALTH PROVIDER’S PERSPECTIVES.
1*Adebimpe, Wasiu Olalekan and 2Adebimpe Mujidat Adebukola
1Department of Community Medicine, Osun State University, Osogbo. Nigeria
2Ministry of Finance, Osun State Secretariat, Osogbo Nigeria
e-mail: lekanadebimpe@yahoo.com and lekanadebimpe@gmail.com com
ABSTRACT
Quality issues are bound to occur in the complex relationship between the different stake holders in the NHIS scheme. Such issues could affect choice of HMOs among health care providers and clients. The objective of this study is to determine factors influencing mode of operation and choice of HMOs among NHIS primary health care service providers in Osogbo in southwestern Nigeria. This was a qualitative, descriptive cross sectional study was carried out among hospital workers focal persons in charge of HMOs activities. Three focus group discussions of eight eligible respondents each were performed using a focus group discussion guide. Analysis was presented in simple proportional forms. All the HMOs were reported to have good reputation with the health care providers in terms of their strong financial base and service coverage. While most offer both capitation and fee for services, very few operates only fee for services. Only few of HMOs defaults in their monthly payments, which may necessitate non provision of services to clients. Referral systems were in place by all NGOs but with weal referral feedback loop. Monitoring activities by HMOs was also been carried out. Clients have had reasons and course to apply for a change of HMOs. HMOs should always arrange an avenue with clients (or body of clients) to discuss their operations, their successes and weakness before making a choice of a HMO.
Keywords: Health maintenance organizations (HMOs), National Health Insurance scheme (NHIS), primary health care service providers