12 Functions of Health Maintenance Organization in Nigeria

Here in this post, we are going to take time to discuss the 12 functions of health maintenance organisation (HMO) in Nigeria.

The Health Maintenance Organization is simply an organization, established for the purpose of providing a wide range of medical services for the Nigerian citizens.

More so, to those who benefited from the medical services of the Health Maintenance Organization, normally pay a fixed amount of money every month, which is the payment in return of the medical services they have benefited from.

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And the organization is made up of medical practitioners, such as, doctors and physicians. Besides, the Health Maintenance organization is working under the direct supervision of the Federal Ministry of health.

Apart from rendering such wide range of medical services to the general public, the Health Maintenance Organization is also saddled with several responsibilities and functions, and in this article, I am going to explain some of these functions assigned to the Health Maintenance Organization

What Are The Functions Of Health Maintenance Organization?

At the very onset, when the Health Maintenance Organization was established, it was assigned with a number of functions, and l am going to explain some of these functions in this article. Below are the functions of the Health Maintenance Organization.

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1. Health Maintenance Organization Collects Donations From Contributors

There are contributors, who have volunteered to contribute donations in order to assist the Health Maintenance Organization to drive its functions successfully towards actualising the purpose to which, the Health Maintenance Organization was established.

Going by this, the Health Maintenance Organization is saddling with the responsibility of making sure that these donations from the volunteered contributors are collected.

2. Health Maintenance Organization Compiles Contributions From Employees

In the Health Maintenance Organization’s Act, there is provision for certified employees and certified employers to be registered under the private health insurance.

Therefore, as part of the functions of the Health Maintenance Organization, they are to make sure that, they compile every contribution collected from these certified employers and employees. Their database must be up to date, very important!

3. Health Maintenance Organization Assures Effective Procession Of Claims

To ensure effective and efficient discharge of duties on the part of the Health Maintenance Organization, there must be an assurance of effective procession of claims.

And so, the function of the Health Maintenance Organization has been to make sure that, there is this assurance that the procession of claims is carried out more effectively and also in a good and timely manner.

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4. Health Maintenance Organization Ensures Timely Payment Of Duty

Within the Health Maintenance Organization, are the primary health care service and secondary health care service running concurrently, serving the general public.

Accordingly, the Health Maintenance Organization at this point is expected to ensure the payment of, first duty to primary care infrastructure and then secondly payment to free-for-service to secondary health care infrastructure. It is very important that the Health Maintenance Organization make this payment to both secondary and primary health care facilities timely.

5. Health Maintenance Organization Clarifies Monthly Scheme Returns

Another function of the Health Maintenance Organization is in the area of making sure that, it clarified the scheme of returns on both the duty and the free-for-service payment every month within thirty days of the following month.

So clarification of this scheme returns monthly, on duty and fee-for-service payment is part of the Health Maintenance Organization’s function.

6. Health Maintenance Organization Collects and Submits Data Forms

Encounter data forms are collected from health care facilities by the Health Maintenance Organization. This another function of the Health Maintenance Organization.

What the Organization does is that, it will not only collect this encounter forms from the health care facilities, it will also make submission to the National Health Insurance Scheme NHIS, after collection from the health care facilities.

7. Health Maintenance Organization Contracts with Health Care Facilities

The Health Maintenance Organization also enter into contracts, but in this case, the Health Maintenance Organization will only contracting with health care facilities that are accredited by the scheme.

The reason is obvious. It is for the purpose of making sure that, health care services are rendered. This of course, is also a major function of the Health Maintenance Organization.

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8. Health Maintenance Organization Keeps Contributions In Accredited Banks

I have said that, one of the functions of the Health Maintenance Organization is to collect contributions from volunteers as donations, and having collected these donations, it is the function of the Health Maintenance Organization to also make sure that, these contributions are kept in not just any banks but those banks that are schemes accredited.

9. Health Maintenance Organization Establishes And Ensures Quality Assurance System

It is the function of the Health Maintenance Organization to make sure that, they established assurance system, and as well, make sure that, they ensures quality assurance of this system in order to provide quality health care for the general public.

Besides, there must be quality assurance monitoring of these health care facilities by the Health Maintenance Organization.

This quality assurance monitoring of health care facilities is quarterly done, while the reports of the quality assurance monitoring of health care facilities is sent to National Health Insurance Scheme within the period of one month.

10. Health Maintenance Organization Ensures Timely Approval Of Referrals

This is another function of the Health Maintenance Organization. It is the function of the Health Maintenance Organization to ensure that there is timely approval of every referral, and they also have to undertake the necessary follow up to make sure that,  the referral is complete.

11. Health Maintenance Organization Carries Out Continuous Sensitization

Sensitization of enrolees is another function of the Health Maintenance Organization. So it is incumbent on the part of the Health Maintenance Organization to ensure that they continuously carry out this sensitization of enrolees regularly for the purpose of keeping the enrolees up to date knowledge wise to carry out their responsibilities effectively.

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12. Health Maintenance Organization Carries Out Marketing Programmes

Yes, another function of the Health Maintenance Organization do carry out marketing programmes. In carrying out their marketing, the Health Maintenance Organization must make sure that, such marketing is done according to the National Health Insurance Scheme guidelines.

Conclusion

The Health Maintenance Organization is saddled with the responsibility of rendering such a wide range of medical service to the general public.

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