Pharm. Dr. Mrs. C.O. Olumese UBTH Benin City 08072220360 08023381884 Introduction Definition Objectives of NHIS The NHIS Council Contributors Stakeholders In NHIS Health Maintenance Organizations (HMOS) NHIS Operators Steps To Take In Enrolment Into NHIS Payment Systems For Services Rendered Guidelines For The Registration Of Pharmacies And Pharmacists Guidelines On Registration Of Government Hospitals Contractual Agreement With HMOS Contractual Agreement With NHIS The quality of health of a country’s population no doubt enhances productivity, economic growth and development. In spite of the resource constraints, government is committed to improving health care delivery in Nigeria The National Health Insurance Scheme (NHIS) is one of the government’s efforts in this regard. It is the national pooling of contributions from the incomes of eligible persons to provide standard healthcare services to them and their dependants. The Scheme was established by the National Health Insurance Scheme Act, 1999 (No. 35 of 1999). To ensure that every Nigerian has access to good health care services. To protect families from the financial hardship of huge medical bills. To ensure the availability of funds to the health sector for improved services To ensure the equitable distribution of health care costs among different income groups. To limit the rise in cost of health care services To ensure efficiency in health care services To ensure adequate distribution of health facilities within the federation. To ensure adequate patronage of all levels of health care To maintain high standard of health care delivery services within the scheme To improve and harness private sector participation in the provision of health care services Responsibilities: To manage the scheme in accordance with the provision of the act To determine the overall polices of the scheme including the financial and operative procedures of the scheme To ensure the effective implementation of the polices and the procedures of the scheme To assess from time to time, the research consultancy and training program relative to the scheme To arrange for the financial and medical audit of the zonal health insurance offices established under the section 21 of the act. To ensure public awareness about the scheme To coordinate quarterly returns from the zonal health insurance offices To coordinate manpower training under the scheme. To set guidelines for effective corporation with other organizations to promote the objective of the scheme To carry out such other activities as are necessary and expedient for the purpose of achieving the objective of the scheme as set out in the act any employer who has a minimum of 10 employees 15% of the basic salary to be contributed 5% by the employee 10% by the employer THE INSURED THE EMPLOYERS HEALTH CARE PROVIDERS .Primary health care providers .Fee-for service health care providers a. Secondary health care providers b. Tertiary health care providers DEFINITION: The HMO is a private or public institution body, corporate or a provident association registered by the scheme to utilize its administration to provide health care services through health care facilities approved by the scheme. Zonal HMO National HMO Function of HMO To collect contributions from eligible employers, employees and other contributors to the NHIS. To ensure that all contributors have easy and unhindered access to and receive appropriate health care services from the accredited health care providers. To make payments to health care providers for service rendered. To maintain quality assurance in the delivery of health care benefits to the insured persons. Rendering returns to the scheme as required. Registration requirements Registration with corporate affairs commission certificate of incorporation, articles of association and trust agreement e.t.c. evidence of financial viability Maintenance of account with NHIS approved banks Insurance with an NHIS approved insurance company Completion of prescribed application form including the following information ◦ Names and addresses of the principal officers ◦ Ownership structure and composition of the organization Possession of necessary staff and infrastructure including computerization Payment for stipulated registration, guidelines and other sundries. NHIS council Health Maintenance Organization Heath Care Providers State Health Insurance Arbitration Boards Standards Committee State Health Insurance Boards Fill an NHIS registration form and select any hospital of your choice from the NHIS accredited list of hospitals / clinics as your primary health care provides Get enrolled Receive NHIS ID card Attend hospital when in need at no extra cost CAPITATION- payment made in advance to a health care provider FEE FOR SERVICE- paid for specific services and prices per item Approval and be registered by the HMO despite being registered by PCN The pharmacy shall be pharmacists owned Standards Of Premises OBLIGATION OF THE GOVERNMENT OR PRIVATE PHARMACY OBLIGATIONS OF THE HMOS REGISTERED PROVIDER: means a Pharmacy registered under the scheme. ‘DRUG’: includes any substance or mixture of substances listed in the NHIS formulary ‘ARBITRATION BOARD’: means the National Health Insurance Arbitration Board ‘BILL’: means the sum total of drug costs on all prescriptions presented for payment and the agreed professional charge calculated per prescription. ‘SUBSCRIBER’: means anybody who contributes to the fund and is therefore insured under the regulation establishing the scheme. PRIMARY MEDICAL CENTRE: provide enlistment and initial encounter facilities for enrollees of NHIS outpatient facilities shall have the following minimum features Waiting and reception areas Consulting room Treatment room with cabinet, dressing, injection, trolley wash hand basin injection trolley etc. Adequate Dangerous Drug Act cupboard Patients toilet facilities Drug dispensing room Sterilizer both out patient and in patient services for general, medical, surgical, pediatric and maternal care. They should also have diagnostic and treatment facilities like: - Laboratory including blood bank - X-ray and allied diagnostics Surgical operating theatre Pharmacy dept Lying in ward with locker for each bed Separate ward for male and female First stage labor room Sterilizer Isolation and sluice room Public health facilities Fire extinguisher Nurses bay Doctors room There shall be appropriate administrative outfit for proper co-ordination. PERSONEL: Primary Care: one (1) medical practitioner 2 registered nurses 2 hospital assistants 1 administrative staff Dispensary (supervised by qualified pharmacists). Secondary / Comprehensive Health Care Centre Not less than one (1) registered medical practitioner in relevant areas of medical practice and specialties Not less than four (4) registered nurses and midwives Not less than four (4) hospital assistants Not less than two (2) admin staff. THANK YOU FOR LISTENING!