Cost-cutting measures to access quality health care in 2010

THE PUNCH Newspaper- Layi Adeloye

In a country where health insurance is known and enjoyed by a few, with over 80 per cent of the populace still picking up their medical bills regardless of their employment status, Nigerians, no doubt, have a health care crisis on their hands.

The facts are clear and hardly incontestable. With the larger portion of the populace remaining unemployed or under-employed, the economic malaise in the land has only compounded the already bad situation. Access to health care, in a country like Nigeria, is still seen as a privilege rather than a right. Even within the league of the employed or those who have bought one health insurance product, the fact that there is the absence of a broad-based functional national health insurance scheme still has a peculiar way of exerting added pressures on one‘s purse.

It is not surprising that the ongoing public health mission initiated by the Lagos State Government, reminiscent of the colonial and early post colonial era of the 1950s and early 1960s, is seen as a much needed in the current circumstances. Then, missionaries and public health institutions took health care services to the rural folk in villages and suburban areas. The Lagos State health mission, which has a programmed target of spending a week in a particular locality (local council), is replete with all the fundamental medical staff and equipment needed to cater for the primary health needs of the people. For three months, residents of Lagos and its environs have been singing praises of the governor, Babatunde Fashola, and the new mobile medical services initiative.

Why is this so, especially in a country with 4,671 registered private hospitals and clinics, and not less than federal tertiary public health institutions? Notwithstanding its overall retrogressive social implication, in the words of Dr. Hakeem Adebowale, one of the operating general practitioners at the Oyewole Primary School Centre of the public health scheme in Agege: ”The importance of this scheme has been magnified by the general poverty among the people. Apart from ignorance about the actual cost of visiting hospitals, many of those who visit find it difficult to purchase the prescribed drugs, which underscores the state‘s decision to take medicare to the people‘s doorsteps.”

But definitely, this is one way of accessing cheap and functional health care, especially the unemployed.

On a slightly higher scale, a beneficiary of a running privately arranged health insurance scheme, who pleads anonymity, says, ”…it is like the health insurance thing is not quite cutting it (the cost burden), as I have had to pick up more of my medical bills.”

But amidst the crisis, experts say there are measures that can still give individuals access to quality health care, and yet, at a very low cost. According to them, the whole issue is about adjustment and innovation.

Dr. Bolurin Adepitan, the Medical Director of Hillcrest Clinic, Ogba, Lagos, believes that regardless of one‘s social status in the society, everyone can have access to the required health care.

According to him, a determined search for free health care can always yield fruitful results. He says, ”Medical aids agencies are all over place. While private medicare may be costly and inaccessible, the right contact with any of the federal or donor medical aids institutions can provide the needed succour or link to the right treatment. Besides, the Internet provides a cheap option, where one can confidentially talk to experts almost free of charge.”

Another way of accessing good medical treatment at an affordable rate, as suggested by the medical practitioner, is for people to make use of out-patient services in hospitals. According to him, many procedures, even simple surgeries and invasive tests, can be done without being admitted as an in-patient. What such a patient needs to do is to arrange to arrive at the hospital first thing in the morning so you can have the necessary procedures undertaken immediately and be home by evening. The truth is that being an in-patient, especially in cases not deemed serious for rigorous monitoring, can be costly. But the common complaint, especially against public hospitals, is that much time is wasted. ”If you want to lower your cost and still get qualitative medical treatment, I think it is reasonable for any patient to be punctual and possibly be prepared to spend time at the right government hospital. The option is to patronise quacks or end up paying high bills in private hospitals,” he says.

Steve Blake is a foremost hospital administrator in Nigeria. With over 30 years’ experience, he has some pieces of advice on how the poor can lower the cost of their health care in his book, ”The Poor‘s Health Concerns.”

According to him, one of the ways to minimise or lower health care cost is to register with a public health institution, at least for medical consultation. Another way, he says, is by getting one‘s admission timing right, except in a case of emergency. His advice, ”Don‘t check into the hospital on a Friday, unless it‘s an emergency as you stand to blow so much money on little or no service (at the weekends).”

Blake also advises on the need to be innovative in seeking medical attention. For instance, he says it is not every time that one goes to specialist or conventional wards of open hospitals for treatment. A patient with a tooth problem may not necessarily go to a dental hospital or a dental ward of a private or conventional hospital for treatment. ”You can choose to go to a dental school of a university as most of them have low-cost clinics for the public. There is nothing to panic or be anxious about. The people wielding the drill are third and fourth-year students. Besides, they are being well supervised. Here you can have your treatment almost free,” he says.

The expert also suggests what he called ‘comparison shop‘ theory. According to him, it is not always cost-effective just to take your doctor‘s word for it – you have options! You can save big money by looking for a laboratory or a pharmacy with better prices.

Dr. Deborah Lawani works with one of the leading Lagos-based Health Management Organisations. According to her, having the right health insurance plan can be one of the most cost-effective means of managing one‘s healthcare. But she warns, ”Don‘t just assume that your health insurer is giving you all the benefits you are entitled to. Be sure to check for discounts for the various benefits included in your policy. These savings can really add up and you will never know if you don‘t ask!”

Another medical expert, Dr. Gabriel Adebo, a retired consultant pediatrician, sums up the smart move strategies. According to him, ”Taking pre-emptive steps could prevent heavy spending on medicare. A lot of people hardly go for simple check-ups for high blood pressure, diabetes or glaucoma tests among others, early. Detecting these early is key to bringing down the cost of medicare.”


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