Public–private partnership: how successful is the NHIS – HMO collaboration in health care delivery in Nigeria?

Abstract

Collaboration between the National Health Insurance Scheme (NHIS) and Health Maintenance Organizations (HMOs) is a form of public-private partnership in health care delivery in Nigeria. National Health Insurance Schemes’ adoption of Health Maintenance Organizations to manage NHIS enrollees is seen as an effective and efficient means of running the scheme. The effective performance of Health Maintenance Organizations’ role in the scheme, leads to increased access to health care services and ensures the overall achievement of NHIS goals. These organizations work on certain intricate modalities that do not allow HMOs to set their prices in managing NHIS enrollees but are still expected to ensure that enrollees are properly managed based on the agreed modalities for collaboration. If the scheme is successfully managed by the HMOs, there is the likelihood that the goals and objectives of NHIS would be achieved. And if not, NHIS goals would not be achieved. This is why the paper sought to investigate how this form of collaboration operates and the challenges that could result from collaboration. To achieve this therefore, a review of literature was done to highlight the functions of HMOs in Nigeria’s NHIS, and the possible challenges that could come with this form of collaboration. In undertaking this study, nine in-depth interviews were conducted with representatives of participating organizations. At the end, the study discovered that HMOs played a prominent role in ensuring that the scheme is well implemented. The study therefore recommended that there should be constant review of the modalities on which the two organizations work as partners.

Keywords: Public-Private Partnership, National Health Insurance Scheme, Health Maintenance Organization