Document

Report
Pharm. Dr. Mrs. C.O. Olumese
UBTH Benin City
08072220360
08023381884
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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
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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
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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.
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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).
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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
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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:
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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
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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
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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
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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
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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
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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.
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Zonal HMO
National HMO
Function of HMO
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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.
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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
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Completion of prescribed application form
including the following information
◦ Names and addresses of the principal officers
◦ Ownership structure and composition of the
organization
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Possession of necessary staff and
infrastructure including computerization
Payment for stipulated registration,
guidelines and other sundries.
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NHIS council
Health Maintenance Organization
Heath Care Providers
State Health Insurance Arbitration Boards
Standards Committee
State Health Insurance Boards
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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
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CAPITATION- payment made in advance to a
health care provider
FEE FOR SERVICE- paid for specific services
and prices per item
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Approval and be registered by the HMO
despite being registered by PCN
The pharmacy shall be pharmacists owned
Standards Of Premises
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OBLIGATION OF THE GOVERNMENT OR PRIVATE
PHARMACY
OBLIGATIONS OF THE HMOS
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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
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‘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.
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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:
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Laboratory including blood bank
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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
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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).
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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.
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THANK YOU FOR LISTENING!

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