poverty CSJ PRO expert FUNDING health plans FG specialised Performance BANK SCIDaR
Healthcare Financing

Inflation: Adopt Tariff-reflective System, Private Dental Practitioners Task NHIA

With the surge in inflation in Nigeria, private dental practitioners have lamented what they described as a ‘cap fits all’ health insurance system, calling on the National Health Insurance Authority (NHIA) to ensure a tariff-reflective system to guarantee quality and sustainability in health services.

Giving the recommendation in Lagos, the President of the Association of Private Dental Practitioners in Nigeria, Dr. Afolabi Ogunderu lamented that despite the incremental inflation over the years, there has not been a reflective tariffs system in the country’s health financing scheme.

“The National Health Insurance Scheme which was started in 2003, the tariffs have only been reviewed twice and the review was less than double digits but you and I know that inflation in Nigeria over that period, year in year out has been in double-digit inflation. What it means is that it’s been cumulative.

“For instance, if you say you’re doing a procedure at N4,000 in 2003 which is 20 years ago and the current tariff that is being used is about N7, 000 that means you had just maybe N3000 increments over 20 years. It makes no sense so what it means is that there’s been a lot of charity programmes being done and it’s not sustainable.

“Healthcare is a form of business but it’s a business that has regulation and has a conscience because it is service first but that service has to be sustained and has to be quality. So the recommendation for NHIA is very simple, we can’t operate the current system we operate where a cap fits all,” he stated.

Ogunderu said there has to be a contribution from the operators.  “If 80 percent of healthcare service in Nigeria is by the private sector, and governments regulate based on the 20 percent they are providing. We know that from the beginning it’s a failure. So what we need to do is to bring in the private sector and let’s look at tariffs reflective system,” he added.

Lamenting that a couple of multinationals have exited Nigeria, he cited an example with inhalers that were N3000 as of last year which has risen to as much as N22,000.

“So if within a few months we had that surge, and you are not having a cost reflective tariff, what you have invariably said is that for survival to be, quality must be compromised. And that’s what we are trying to avoid as a professional body. We cannot afford to have what looks like anybody coming into the game without standards.

He stressed that the NHIA needs to be reflective of the current economic realities as about 42 to 45 percent of the overhead costs of private dental practitioners are in power.

“A lot of us run diesel. I did a study last year on behalf of my association and found out that everybody that uses about 20 KVA Generator and above spends an average of N14 million a year on diesel. That’s about N1.1 million a month.

“Let me break it down with you. A dental clinic opens on average between 24 to 26 days a month. What it means is that if the health insurance patient from NHIA and HMOs, comes into the clinic and occupies eight hours or 12 hours for those 24 to 28 days, we cannot break even. So automatically what it means is that that is just on power, which is 42 percentof the average cost to 45 percent of the overhead costs. We haven’t talked about equipment, we haven’t talked about materials consumables, and all the like. We have not talked about personnel costs and replacement of equipment.

“With the current forex, it’s not possible.  I still checked the receipt in 2014 when I went to Dubai for training, dollar was N187 at that time, today it is over N1000 and we have some health insurance organisations whose tariffs have not been reviewed.

“Last year, a review was done where they said about 30 percent but it was never implemented. So between 2014 and till date which is nine years we have had a surge in forex of more than 2000 percent and the tariffs are not reflective. Of course, it’s not going to work,” he added.

He said the fuel subsidy removal which has ballooned overheads coupled with costs from materials, consumables, etc including the spike in the exodus of clinical hands overseas has altered the entirety of private dental practitioners.

Statisense 2019 revealed that 1,350 dentists are based in Nigeria and that about 500 to 700 were in private practice in Nigeria 1 dentist attended to 88,885 patients. “1 strongly doubts that there are up to 10 dental practices in Nigeria with a registration of up to 80,000 patients since inception.”

He said regulation of their profession was key as they cannot sit and allow charlatans to take over their profession. “Influx of foreigners is a wakeup call for us to take the bull by the horns so we do not go the route of South Africa (pre and post-Apartheid).

“The need for a dental council is now for us to get ourselves or we lose control of our profession, if the apex of the dental profession is the dentist, then regulation should be by dentists. Unfortunately, the current system is not about the Medical and Dental Council, MDCN as constituted. The medical profession by extension is the most regulated profession in Nigeria which is why we have the state regulatory agencies that contradict the Nigerian constitution.

“About 22 dental clinics are responsible for close to 75 percent of the cash flow of enrollees under the third party agreement we currently run. A cartel system to determine minimum tariff, patient allocation, and clinic stratification is needed for us to run an effective and third-party perineural system. Dental practice by definition is a business and like any business must be profitable,” he stated.

On effects of japa syndrome on health services, a past president, national president of the Nigerian Dental Association, and Associate professor of oral and mandibular surgery, at the University of Lagos, Dr. Clement Oluwarontimi said enough of playing the ostrich and taking the bull by the horn.

Lamenting that Nigeria was yet to learn from the experiences of COVID-19 to do the right thing, and the way the whole thing came about, Oluwarontimi said: “It’s a pity that we train medical personnel to be taken by other countries. I know many of us, a lot of us who are outside there, if the welfare package here is good and the atmosphere is also fantastic, many of my colleagues, both senior colleagues and junior ones, will want to come back and take care of Nigerians. This is because the clientele is here.”

SOURCE: Vanguard