Welcome to Planning & Development

(A) Brief Information on the Department

The Planning and Development Department commenced operation as a Unit under the General Administration Department in the year 1984. It was upgraded to a full-fledged Department in February 1991 with the following mandate/functions:

  1. Housing and Development Committee of the Board
  2. Staff Housing Loan Scheme Committee
  3. The Computerization of Hospital Information System Project Committee
  4. OAUTHC Joint Services and Development Committee
  5. Insurance Matters
  6. Hospital Fees Regulation Committee
  7. Budgeting
  8. Statistical Matters
  9. Strategic Planning
  10. Staff Identity Card
  11. Baby Friendly Hospital Initiative
  12. Any other matters directed to the Department by the Management

During the year 2011, the Planning and Development Department under took the underlisted activities

National Health Insurance Scheme

The National Health Insurance Scheme is a Social Health Insurance established under Act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost. It is a Scheme where the enrollees contribute certain percentage for his/her health demand/services at the point of treatment. The Scheme took off effectively in OAUTHC in September, 2005. The following are the stakeholders:

  1. The National Health Insurance Scheme (NHIS)
  2. The Health Maintenance Organizations (HMOs)
  3. The Healthcare Provider or the Health facilities e.g. OAUTHC
  4. The Participants i.e. the enrollees or the patients (of the Scheme).

The Operational Modus

There are two (2) types of services under the National health Insurance Scheme (NHIS).

  1. The Day-Case:

    In this respect, the patient comes to the hospital, registers at the Health Records, sees a Doctor, gets an NHIS prescription sheet, goes to the Pharmacy to collect his/her drugs with payment of 10% cost of drugs and goes home. He or she does not need to pay for the full cost of the drugs except 10% cost of the total amount which is supposed to be kept with the Pharmacists to keep on their services of providing drugs as at when due. All other amount on drugs and services had been paid for in advance. The monthly capitation per enrollees is paid by the HMO in advance. Where there is default, the Planning and Development, who is the supervising departments, will contact such default HMO immediately.

  2. Fee for Services

    This case involves those who come for admission or needed to be hospitalized. Once the NHIS patient is hospitalized the HMO involved should be contacted within 24 hours. If it is weekend or public holiday, the contact should be made immediately the work resumes otherwise, the hospital will lose the money or revenue out-rightly. The essence of contacting the HMO is to obtain an authorization code so that claim could be settled for the treatment and forestall a denial. The HMO will not pay for the treatment i.e. admission that is not authorized. Hence, obtaining the authorization by contacting them (the HMOs) is very important for the success of the Scheme.

    When writing to make claim in respect of fee for service, there are some information that need to be included e.g. if the patient was referred, there should be a referral form duly completed by a Doctor either from GOPD or any Clinic in the Hospital. Other form to be included is permission for operation, if the patient had undergone an operation. This is where we have challenges because some HMOs normally do not want to pay. They are fond of giving one excuse or the other but the Desk Officer should not relent, otherwise, the hospital will be losing a lot of fund.

    The last attachment is the medical report dully signed by the physician who treated the patient last.

  3. On-Line Payment

    Payment by on-line is an on-going system of settling capitation. The system will involve giving the OAUTHC account to the HMOs for settlement of monthly capitation or fee-for-services on-line.

  4. The Health Maintenance Organization (HMO

    The count-down of the HMOs we are dealing with is twenty-three (23). Many of them are not giving us problem, but quite a few of them are very problematic when it comes to settlement of claims. The most difficult of these HMOs is the Wise Health Services Limited.

  5. List of Health Maintenance Organization

    The list of HMOs we deal with now are as listed below:

  1. Premier Medicaid Limited (HM) 015)

    This is the HMO that is responsible for our Institution. The Company has a representative working with us. He shares office with our staff, because Management was still scouting for an office for him.

  2. Hygeia Nigeria Ltd.
  3. Total Health Trust Ltd.
  4. Clearline
  5. Health Care International Ltd.
  6. Mediplan Health Care Ltd.
  7. Multishield Nig. Ltd.
  8. United Health Care Int. Ltd.
  9. Premium Private Health Trust Ltd.
  10. Ronsberger Nig. Ltd.
  11. Inter Health Management Services
  12. Expatcare Health Int. Ltd.
  13. Wise Health Service Ltd.
  14. Songhai Health Trust Ltd
  15. Princeton Health Group.
  16. Integrated Healthcare Ltd.
  17. Wetlands Health Services Ltd.
  18. Zenith Assurance Medicare
  19. Managed Health Care Services
  20. Platinum Habbib Bank Insurance PHB Healthcare
  21. The Prepaid Medicare Ltd.
  22. Maayoit Healthcare Ltd.
  23. The Ultimate Health Care Ltd.

OPERATION AND MANAGEMENT OF TERTIARY INSTITUTION HEALTH INSUANCE PROGRAMME TISHIP

The Tertiary Institution Health Insurance Programme (TISHIP) came into being in OAUTHC in January 2010. The programme made provision for students in our various Institution of Higher Learning who are above Eighteen (18) years of age as at the time of registration to benefit from National health Insurance Scheme just as it has been enjoyed by other members of staff in other Health Institution.

For now, the HMO Premier Medicaid is the licensed HMO for the operation of TISHIP in OAUTHC incorporating the Schools of Nursing and Midwifery, the School of Darkroom Technician. The Peri-operative Nursing Students, the Medical laboratory Students,. the students in Health Records and the Community Health Officers Training Programme Students were all enrolled in for the Scheme.

The operation of TISHIP is a little bit different from the NHIS Programme simply because students in this Institution need not pay 10% co-payment on the point of collection of drugs as it is being done by other staff operating on NHIS. Secondly, all the students of these Institution are required to renew their premium yearly into the coffers of HMO Premier Medicaid as at when due. This will form the bulk of their capitation into the OAUTHC i.e. Providers Revenue Accounts. It is to be noted that all students involved are given a card showing the registration number on the commencement of the Scheme.

RETIREES HELATH INSURANCE SCHEME

This operation is being arranged for the retired members of staff. The National Health Insurance Scheme (NHIS) Abuja is working seriously on this Programme. When it comes into the lime light, it will provide a great opportunity for all retired members of staff who had not been opportuned to benefit from the current Tertiary Health Social Insurance Scheme that had been put in place some years back.

For now, all our retirees needing medical attention would have to buy drugs, pay from their purse and later on seek for reimbursement from the Management on collection of letter of authority to do so by the Management before the money could be refunded.

PASSENGERS IN TRANSIT HEALTH INSURANCE PROGRAMME

This is another Programme put in place to assist travelers going from one station to the other. The Scheme is managed by the erstwhile Platinum Habbib Bank (Bank PHB)

With the Scheme, Passenger travelling from one station to the other needing treatment will contact the HMO (PHB) on phone, obtain code, get treatment with certain percentage and get discharged. With the Scheme, there is a card showing the picture of the enrollee and the registration numbers indicating that the enrollee is from the accredited HMO for treatment. All the bill will be settled by the HMO, Bank PHB.

The following are the Guidelines on Implementation of National Health Insurance Scheme

The underlisted guidelines need to be strictly adhere to when implementing NHIS:

  1. Feeding

    The NHIS Scheme does not cover feeding of patients hence all NHIS enrollees (patients) are to pay for their feeding while on hospital admission.

  2. Children

    Children below age of six (6) months are to benefit under the NHIS cover of their parents.

  3. Admission Beyond 15 days

    Only fifteen (15) days admission per year is covered by the NHIS. Bill for the excess days spent after the stipulated fifteen (15) days shall be settled by the concerned patient (enrollees)

  4. Information on Admitted Enrollee

    Information from stakeholders on admitted NHIS patients is required by the NHIS Unit of the Planning and Development Department in order to facilitate writing to claim for fees for services from the appropriate Health maintenance Organization (HMOs) within the stipulated period

PROBLEMS AND CHALLENGES ENCOUNTERED IN THE IMPLEMENTATION OF NATIONAL HEALTH INSURANCE SCHEME

  1. Irregularity in allocating Health Care Facility not chosen by enrollees. Some OAUTHC staff members chose OAUTHC as their Health Care Organization but they were given Adenle Memorial Hospital and/or other hospitals not chosen by them (as first choice)
  2. Reluctance and/or delay by some physician in writing detailed Medical Report for patients – this has adverse effect on our ability to get reimbursement for services rendered for enrollees
  3. Short supply and/or delay in supplying registration form thereby denying prospective enrollees from benefiting from the scheme
  4. Delay in issuance of identity cards for enrollees
  5. There is no identified NHIS drug list thereby putting all drugs including specialized and expensive drugs under the scheme
  6. No definite pronouncement on how much each enrollee is entitled to in terms of cost of drug to be collected per prescription, i.e. what is the maximum amount expendable on a patient per prescription.
  7. Because the scheme is highly subsidized, some enrollees insist on collecting 2-4 months supply of drugs at a time, especially when given appointment time, not minding the cost of such drug items and/or the need to keep them in conducive condition for future use.
  8. Some physicians prescribes long list of drug items as a routine.
  9. Delay by some Health Maintenance Organization in releasing reimbursement payable for services rendered.
  10. Some of the HMOs have not cooperated enough in releasing accurate list of enrolled patients to our Teaching Hospital. This is adversely affecting capitation fees payable to us as a provider.

(B) HANDLING OF INSTITUTION’S INSURANCE MATTERS

The department liaised with the Institution Main Broker, Messrs Femi Johnson & Co. Limited as well as the Institution’s underwriter, Law Union & Rock Insurance Plc to ensure that all the assets of the Institution were given full adequate insurance coverage.

During the year 2011, the Institution held four (4) policies and the premium on the policies were paid on quarterly basis

Besides that, the Institution also insured all the Medical Doctors in its employment under the Doctor’s professional Indemnity Insurance. The Doctors were responsible for the payment of their premiums

Also, the Institution insured its entire staff under the Group Life Insurance Scheme in compliance with the directive of the Federal Government of Nigeria. The premium for this Group Life Insurance Scheme would be taken care of by the Federal Government through the office of the Head of Service of the Federation.

(C) SERVICING OF HOSPITAL FEES REGULATION COMMITTEE

The Department provided Secretarial coverage for the hospital fees Regulation Committee which reviewed charges payable for various health care services rendered by the hospital periodically in consultation with various departments. The charges were reviewed last on 1st November, 2007 while charges for anesthetic services were reviewed upward with effect from 6th February, 2008.

(D) NATIONAL HOUSING FUND

The department was involved in processing refund claims of retired officers who had participated in the National Housing Fund Scheme while in service.

(E) STAFF IDENTITY CARD

During the Year 2011, the department organized issuance of Identity Cards to members of Staff that needed them.

(F) BUDGET PREPARATION

In 2011, the Department alongside other relevant departments prepared and submitted the underlisted budget documents to the Federal Ministry of Health.

  • OAUTHC 2011 workplan
  • Capital Budget Analysis for 2010 & 2011
  • 2012-2014 Medium Term Sector Strategy (MTSS) Capital Projects
  • 2012 Personnel Budgets

(G) SERVICING OF STAFF HOUSING LOAN SCHEME COMMITTEE

The Department provided administrative and Secretarial service coverage for the staff Housing Loan Scheme Committee. The Committee met once in 2011 and approved housing loans worth 4.8 million for 12 members of staff (senior and junior).

OTHER FUNCTIONS

Other functions performed by the department include the following:

  • Providing administrative coverage for Planning Cell for Budget Implementation
  • Processing applications of staff members for internet connection.
  • Providing administrative Coverage for Quality Assurance Committee
  • Representative of Director of Administration on the Board of Survey
  • Providing administrative Coverage for strategic plan
  • Providing administrative platform for Computer Implementation Committee (MINPHIS).

(I) PREFERRED E-MAIL ADDRESS FOR THE DEPARTMENT

planninganddevelopment@oauthc.com

T.A. Olubodun

Head, Planning and Development Dept.