IVES MEDICARE GENERAL MANAGER THROWS LIGHT ON HMO OPERATIONS AND HEALTH INSURANCE

In this interview, the General Manager of Ives Medicare Limited, (Health Maintenance Organisation), Mr. Adewale Ishola, speaks on how the health insurance scheme works. It is very educative and informative. So, sit back and enjoy it.

How is awareness affecting the health insurance scheme?

Awareness level is very low and can be extremely discouraging. It is supposed to be the duty of government to enlighten the public via every means. A lot of people don’t know what health insurance is about. Even people who know are not ready to buy it. Some will tell you they have not fallen sick or visited hospital in the last five years so why should they buy health insurance; just like you don’t want to insure your car because you have never had an accident before. Nobody wakes up in the morning, starts his car with the aim of having an accident. Accidents happen every day on our roads in this country. Nobody prays for it but it happens, hospitals are being filled every day. When it happens, will you have enough money to take care of it? Most of the time, the answer is ‘No’. We go to companies, associations, different places to talk to them about health insurance.

What is the process of registering for health insurance like?

All an individual needs to do is to come to us, call us on phone or invite us and we will go to him and give him a form. Also, we have our form online and if you visit our website you can fill and send to us with your passport photograph. After that, we will make identity card for you and send your details to the hospital you have chosen. At the back of our proposals are our registered hospitals nationwide; so, you choose any of the hospitals that are closest to your place of residence because a health emergency can happen anytime and we don’t expect you to start running to a far place because you have malaria or something more serious.

How is premium charged to access health insurance?

For corporate or private organisations, it is at their discretion. Some organisations will not even deduct anything from staff salaries. It will be part of the benefits of the staff. Some will deduct from their salaries but it depends on what policy they are buying. For instance, if they buy a policy of N30,000, you divide the N30,000 into twelve places and that is the amount they will be deducting from each member’s salary every month. The company would have paid as a whole not that they will be paying every month. We accept payment twice a year; we can even accept four times depending on the volume of the enrollees and if the money is high. The reason we are always very careful about how we take money depending on the number of enrollees is that we rely on the principle of health insurance.

What are the main principles of health insurance?

One of the main principles of insurance is that the purse must never go dry, it must never be empty. Once the purse of an insurance company is empty, there will be problem. There must always be something in the purse because we will always need to pay for someone that is ill at any moment. Everybody cannot fall ill at the same time, but if anybody falls ill, you have to pay. If you owe hospitals and you don’t pay them on time, you are spoiling the business for yourself because they will start treating your enrollees badly. And again, people go to hospitals now to ask for which Health Maintenance Organisation they should choose. The hospitals only talk about the HMO that pays them regularly as the good one. So, if you don’t pay the hospitals on time, you will lose referrals.

Does health insurance cover things like fertility treatment and IVF?

Health insurance can actually cover everything, depending on the amount the person is ready to pay. Don’t forget that what we manage is risk. For instance, in most health insurance all over the world, cancer is under an exclusion list. Things like kidney transplant and others will be under the exclusion list. The reason is because those kinds of diseases are terminal. And those are diseases we will continue to manage and they are of high cost. Health insurance runs away from anything that will empty the pool easily. The reason is that if the pool is empty on just the patient that has cancer, what happens to the one that has typhoid, malaria and others. Malaria kills, as common as it is; so, it has to be taken care of as well.

What other things will be considered if someone wants his/her health insurance to cover terminal illness?

If someone wants to cover cancer, fertility, IVF, all these things for individuals, and dependents – if you want to cover the families too – a certain premium should be paid, which can be high. All we don’t want is for the pool to go dry. We want to assume that at the end of the year, maybe nobody will come up with the issue of cancer or fertility or kidney transplant. So, it is a risk and assumption because if in that company, there is already a cancer case you have to let us know. We need to know why you want cancer covered. We may then look at it and say we may not be able to insure those that already have cancer but we will make sure that we will manage them for you at extreme minimal cost.

If a person already suffering from terminal illness is denied cover, how can the HMO still manage his/her health?

We have the agreement with every hospital we are registered with. So, even if you are not covering the cancer for the organisation, we will make sure they don’t pay more than what a HMO will pay normally for such. For instance, if you are walking into an hospital as an individual to treat malaria, some hospitals can treat malaria for you for as high as N10,000. But for HMO enrollees they cannot because we already have pre-tariff arrangement of agreement with them. If there is case of cancer, of course, we will charge you far higher than we normally charge. If we are lucky maybe none of you will have it, but if we are unlucky, maybe one or two of you will have it. And with what we have taken from you we will be able to manage it without the purse running dry.

What is the way forward for health insurance scheme in the country?

The government should consider it important to make it compulsory. By this the public will have no choice but to make it compulsory. Awareness should be created so that everyone will be fine in this country. A lot of people cannot even afford to take care of malaria as simple as it is, it kills. With health insurance, people will pay less, hospitals will make more money, more equipment will be bought and all things will work well. My advice for people is that they should not say because they have not fallen sick in many years they won’t take health insurance. That is because sickness can come at any time. For instance, if you need to do caesarian section which could cost almost a million naira, it will be much cheaper with the HMO.

What is the relationship between Ives Medicare and St. Ives Hospital?

St. Ives Hospital actually gave birth to Ives Medicare. Apart from it being a normal hospital, it is also a fertility health care centre that specialises in fertility services like in vitro fertilisation and gynaecology. In partnership with St Ives Hospital, we are giving 50 per cent discount on our IVF services and this promo ended in August. If you are our client and you need to do IVF, you already have a 30 per cent discount in place. As long as you are an enrollee of Ives Medicare, for IVF and fertility investigation, you get 30 per cent discount as our enrollee.

In terms of your operations, what are the main services Ives offers?

Ives is a managed care organisation registered in Nigeria and accredited by the National Health Insurance Scheme for the purpose of providing health insurance coverage for individuals, organised groups, corporate bodies and government parastatals to access quality health care services from an exclusive network of clinics, hospitals, pharmacies and diagnostic centers nationwide. We have outstanding position through product innovation, exclusivity of service providers, high level of service, personalised health care and simplicity of process. We do registration on retail level, staff of corporate organisations, members of association, families, because health is for all. We have over 170 million people in this country and health is for everybody irrespective of your status. So we cover everybody.

How did you survive the last recapitalisation in the sector?

Ives Medicare has always been a profound health maintenance organsation right from the beginning. Even before the initial accreditation, we were more than qualified for the accreditation. When they had to re-accredit, we were one of the first sets of firms to be accredited because we had everything NHIS required. We have fantastic staff and we have all the applications and software needed for a HMO to operate. Also, we have a backup of hospitals.

What are you doing to increase your capital to operate?

The minimum (requirement) is N100m share capital for states, N250m for regional and N400m for firms to operation nationwide. For now, our capital base is N100m but we are going to recapitalise before the end of the year to national, which is N400m. Now, we have hospitals registered nationwide. If we register you in Lagos now and you come under the scheme and you go out of Lagos, we don’t expect you to run back to Lagos because you choose a hospital in Lagos, all you need to do is to call and inform us that you need medical care and we will ask for where you are and call the hospital closest to you, informing the management that one of our enrollees will be coming to them and that they should attend to her. The reason why we have to call is that we only send your details to the hospital you have registered with every month in Lagos. Other hospitals don’t know you, which is why we have to call them and when we do, they will take care of you.