CLEARLINE International Limited is a Health Maintenance Organization (HMO), duly registered by the National Health Insurance Scheme (NHIS) to underwrite health insurance as stipulated by the National Health Insurance Law of 1999. Using the healthcare financing management scheme to pool little contributions into a fund that will be accessible to all contributors, each getting medical services far in excess of their contributions by using multi-disciplinary techniques, especially hospital administration, actuarial valuation and risk management procedures. Their vision is to be a leader in the industry, ensuring that every Nigerian has access to quality, equitable and affordable healthcare.
Speaking with ENCOMIUM Weekly, the Executive Director, Operations and Medical Services and the Acting Managing Director (MD), Dr. Akin Akintunji enlightened us on what health maintenance organization (HMO) is all about…
People talk about health insurance. Sir, can you tell us what HMO is all about?
Health Maintenance Organisation (HMO), is an emerging business in Nigeria. It is a scheme where people pay a little amount of money to receive the very best of treatment in their hospital of choice. This scheme stops out of pocket payment for medical service as is practiced all over the world because we don’t want people running helter-skelter looking for money when trouble comes as far as their health is concerned and is systematically coming up strong in this nation.
Nigeria Health Insurance Scheme (NHIS) is a regulatory body for this scheme. We have a population of about 170 million people but only less than 10 million have registered into this scheme. The federal civil servants are all keyed into it, some state governments have their workers keyed into it and some organized private sector workers. So, we are looking forward to a situation where nearly everybody in the country keys into this scheme which is the best way for our people to have access to affordable medical services in the country because it is a game of number. Day in day out, new enrollees are registered and they are enjoying the benefit.
Clearline International Limited HMO seems to be the pacesetter in this line of health business in Nigeria. How did you come to be the best in the country?
I have not stopped telling people that three things are involved in any business. First, having the resources, that is, capital to do a business. Second, know-how to run a business. The third, which is the most important, is integrity. If you have the know-how and you don’t have money, it may not work. If you have the money and you don’t have the know-how, you are in trouble. But if you have the know-how, the money and you don’t have integrity, the whole system will collapse. Apart from having the know-how, the capital base, integrity is paramount in Clearline. We have taken this business seriously. All over the world, people don’t trust insurance but we want to make a difference. The providers (hospitals) we deal with want their money to be paid as at when due, whether it’s the capitation we pay them or it’s the claims we pay to them from time to time. We have placed priority on payment to our partners (providers) because they are the ones that treat the patients, and if their fees are paid as at when due and they are happy, the enrollees will get the best out of them and this has placed us on top of the cards.
Second, prompt response of Clearline is fantastic when issues arise. We have 24/7 call centres with computer systems that has the particulars/database of all our enrollees which has the names, hospitals, working place of our enrollees to give authorization to the hospitals when there is need for authorization, which has been a problem with many other HMO and their providers, because when they need information no one is there to give them. But in Clearline, we have officers manning our call centres 24 hours. Also, any hospital that has more than 50 enrollees of Clearline is given Close User Group (CUG) lines which we pay for. We have distributed not less than 250 CUG lines and the hospitals don’t pay for using this line.
Any establishment that registered with us, we also make available to them this CUG at no cost and this has placed us at higher level than other HMOs. So, our response time, the prompt payment to our providers and easy communications between Clearline, the hospitals and the enrollees.
If people are not getting the services they deserve, the probability of having market failure is there. So, we are doing everything possible to give the best. We have built a strong foundation that will make the business grow because we want to take the health insurance business to the next level in this country, and that is why we made efforts to have our permanent office on this high street.
The government of Nigeria has promised to support any indigenous company/organization that wants to do business genuinely and effectively to promote the well being of the people of Nigeria. Has Clearline International in anyway gotten the government support in this direction?
Yes. Clearline started this HMO business in 1997 and the Federal Government brought on board the civil servants in 2005. The involvement/participation of the Federal Government in the scheme by bringing the civil servants on board gave this business the boost and also confide the legitimacy on what we are doing. People know that if an HMO is accredited by the government, it is an outfit they can deal with. So, in that way, I believe the government had contributed to the emergence of health insurance in Nigeria. But I also would like to say that the basic infrastructure, especially electricity, had to be worked on by the government. Here, we run our generator 24/7 and provide our own power and that cost a lot. So, the government has to provide an enabling environment for us to operate better than we are.
How were you able to recruit the members of staff to be this efficient?
This health insurance business is basically a medical business. If you are not knowledgeable in medicine and you dabble into it, you will go down because people will always want to cheat, not only in this country but all over the world. There are instances where you receive outrageous bills. So, if you are not knowledgeable, you will keep paying bills upon bills. Here in the headquarters we have about eight to ten medical doctors. As we don’t cheat people, we wouldn’t allow people to cheat us. We don’t want the enrollees to be short changed, so we have trained, competent staff to do the job. We have people in all the departments and we have most importantly, a quality assurance department and all this put together help us to perform effectively and efficiently.
Sir, do you have branches across the nation?
To be a national HMO, you must have branches all over the country. We have functioning offices in Ibadan, Abuja, Kano, Maiduguri, Taraba, Gombe, Bauchi, Yola, Enugu, Port Harcourt, Benin and Ado Ekiti. We are privileged to be in charge of the police in the North-East of the country and it is mandatory we have offices there.
Speaking to Nigerians who are yet to come on board, what do you have to say to them?
The awareness of this health insurance is very low in the country despite the fact we have quite a sensible number of HMO registered in the country. It is important that the Federal Government, through the Ministry of Health, should really help to propagate the HMO business just like the pension scheme. When people know about it and taste it, the probability of coming on is there if it is good but people need to know about it. I believe it is the responsibility of our government to make people know that health insurance is available in this country to encourage the people come on board. So far, so good, there have been challenges but it’s worth all the trouble. We are touching people’s lives. For instance, if you are in the scheme and you are pregnant, your ante natal is covered. Even your delivery, whether through normal or assisted delivery, you don’t need to pay extra kobo. More importantly, accidents are covered, emergencies, anybody on the scheme is covered. We went as far as doing Open Reduction and Internal Fixation (ORIF) for accident victims whose bones are broken to give them the best treatment and quick recovery. We have a long list of hospitals. So, you have to choose hospitals of your choice. The beauty of it is that people choose hospitals that are close to their homes.
What does it cost someone to enroll in this scheme?
We have different grades here in Clearline. We have bronze, silver, gold, platinum – it’s a long list. We have gone through to check the minimum that can do the job satisfactorily and we are talking about not less than N20,000 to N25,000 per annum. We have exclusion too where that covers cancer, chronic illness. Though in Clearline, we are ready to cover anything if you are ready to pay the premium.
Can you tell us about yourself?
I am Dr. Akin Akintunji. I have been practicing medicine for 38 years. I studied at the College of Medicine, University of Lagos. I have worked at NNPC as a doctor. I rose to become Director, Medical Services where I was privileged to be in charge of the healthcare delivery for Federal Airports Authority of Nigeria (FAAN) and Nigerian Aviation Management Agency (NAMA). I have been involved in HMO business for 10 years. I am the Executive Director, Operations and Medical Services and the Acting Managing Director (MD) of Clearline International Limited HMO.
– CHINELO EMESIOBI