What is the role of health maintenance organizations (HMOs) in the healthcare sector?

OBINNIA ABAJUE Affordable quality healthcare access has been unavailable to the majority of the population, and the managed care model was not successful largely because it did not provide choices for customers and had low accountability levels. This made it difficult for providers to grow their business or for people to achieve better advantage from scale. HMOs progressively began to do something closer to real health insurance, where they carry the risk of the difference between the cost of the service for the provider and the price paid by people. Where there is a large number of people, the same service on a per capita basis is cheaper to offer. At Hygeia, part of what we seek to do is determine how we can help providers to operate profitably and not squeeze them into the ground. Then, they can operate and make the investments required to grow their businesses. Hospitals are fairly capital-intensive and cash-consuming entities. They must be able to find a way to make those payments and sustain investments. We have to find a way to distribute quality healthcare across a country and mitigate that risk. Our market is not sophisticated enough yet to deal with catastrophe; however, for the vast majority of people this focus on more general care is working for them.

DR. CHIDI UKANDU Currently, health insurance awareness is low as evidenced by a penetration rate that is less than 5%. This is a general issue with insurance, and it is not limited to health insurance. However, I have always believed much more advocacy and sensitization should be done. We need the governments to take a major lead in this. HMOs can only do so much in terms of advertising, but the government can take a major role. In addition, a large majority of the population are in the informal sector. This segment of society is vulnerable, and government is key to reaching this group through additional funding. Back in 2005, African nations came together to make a declaration that 15% of every national budget on the continent should go toward funding health insurance. This lofty goal has not been reached, but the government is determined to see that this picture changes. The general dream is to establish universal health coverage in Nigeria. We are here to ensure that our enrollees’ experience with our services is a source of comfort. We want enrollees to feel that we are the HMO of choice for coordinating their care because we offer an authentic connection founded on concern for our clients’ health.

How are you progressing toward your vision of being the preferred provider of quality healthcare solutions?

OA Hygeia is one of the oldest HMOs, and we were among the first to introduce health management in Nigeria. Hygeia is owned by the same group that owns Lagoon Hospitals, one of the largest private hospitals in Nigeria and the only one that has the Joint Commission International (JCI) global health rating. This sets us apart from the others. Hygeia’s commitment to making quality healthcare affordable to Nigerians means that we are committed to innovating in both product availability and service delivery. Today, Hygeia has the broadest product offering in Nigerian healthcare market, and our willingness to provide coverage for the various strata of the Nigerian society distinguishes us from others that are only willing to take corporate risk in the marketplace.

CU Our target market for insurance is actually the entire country, but we can segment it in a way that allows us to more clearly craft our strategy. We are selling our insurance to every available target market. We are also focusing on leaving every client feeling satisfied and happy. This way, we are growing on the backs of excellent services and truly happy customers. Our degree of connection with the enrollees really sets us apart. We go to great lengths to ensure that our client experience is as good as it can be.