ABSTRACT
This study focused on the operation and
the evaluation of the effectiveness of the Health Maintenance organization. The
aim of the study was to investigate if the Health Maintenance organizations who
are the administrator of the scheme are running the scheme well in Nigeria.
Further to investigate if access to medical care is cheaper with health
insurance when compared to retainership. In order to achieve this, healthcare
international as a health maintenance organization was studies. Literatures on
health insurance were reviewed, questionnaires wee distributed to Healthcare
international staff, hospital on the scheme, and enrolled population in the
public and private organizations. The data collected were analyzed using
percentage method The analysed data reveals that access to medical care is
cheaper with health insurance but the health insurance scheme is yet to be
properly operated in Nigeria
as there has not been enough awareness
and understanding of how the scheme is operated. In conclusion it was recommended
that Federal Government through the Nation Health Insurance Commission and the health
maintenance organization should create a mass awareness about health insurance
and put in place measures on how is should be properly operated in Nigeria.
TABLE OF CONTENTS
Page
Title
Page i
Certification ii
Dedication iii
Acknowledgement iv
Abstract v
Table
of Contents vi
CHAPTER ONE
BACKGROUND INFORMATION
1.0 Introduction …………………………………………………………. 1
1.1 Background Study of Healthcare
International ……………………... 2
1.2 Significance of study ………………………………………………...
3
1.3 Scope of Study ………………………………………………………..
1.4 Research Question …………………………………………………... 3
1.5 Statement of Problem ……………………………………………….. 4
1.6 Objective of Study ………………………………………………….. 5
1.7 Limitation of Study …………………………………………………. 6
1.8 Determination of Terms
……………………………………………. 7
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction ………………………………………………………….8
2.1 What is Healthcare …………………………………………………..8
2.2 What is Health Insurance ……………………………………………8
2.3 Managed Care ……………………………………………………... 11
2.4 Private Medical Insurance ……………………………………….....11
2.5 Health Maintenance Organization
……………………………….... 12
2.6 Forces for Change in Healthcare
…………………………………...14
2.7 Financing Health Insurance ……………………………………….
14
2.8 Transformation of Healthcare Deliveries
…………………………..16
2.9 Devices to Achieve Cost Control
…………………………………..17
2.10 The Operation of Private Health Insurance
………………………...18
2.11 National Health Insurance Scheme
……………………………….. 19
2.12 Establishment of Health Insurance
…………………………………20
2.13 Benefits to the Organization ……………………………………….
26
2.14 Benefits to the Family/Enrollee
…………………………………….26
2.15 Benefits to the Healthcare Providers
……………………………….27
2.16 Working with Healthcare Providers
………………………………..28
2.17
Quality Control Assurance
………………………………………….29
2.18 Healthcare Delivery and the Admin
Implications …………………..31
2.19 Global Healthcare …………………………………………………..33
2.20 Conclusion ………………………………………………………….35
CHAPTER THREEE
RESEARCH METHODOLOGY
3.0
Introduction
…………………………………………………………37
3.1 Research Instrument ………………………………………………...37
3.2 Population …………………………………………………………. 38
3.3 Questionnaire ……………………………………………………….38
3.4 Personal Interview …………………………………………………..39
3.5 Observation Method ………………………………………………...39
3.6 Sampling Techniques and Sample Size
…………………………….39
3.7 Method of Data Analysis …………
CHAPTER FOUR
PRESENTATION AND ANALYSIS OF DATA
4.0 Introduction……………………………………………………….. 41
4.1 Data Analysis and
Interpretation………………………………….. 41 4.2
Data Presentation …………………………………………………. 42
CHAPTER FIVE
SUMMARY CONCLUSION AND RECOMMENDATION
5.0
Introduction
……………………………………………………….. 65
5.1
Summary……………………………………………………………
65
5.2
Conclusion
………………………………………………………… 66
5.3
Recommendations
…………………………………………………. 67
Bibliography ………………………………………………………. 69
Appendices ………………………………………………………… 70
CHAPTER ONE
1.1
INTRODUCTION
Internal Auditing is an independent
appraisal activity established within an organization as a service to it. It is
a control which functions by examining and evaluating the adequacy and
effectiveness of other controls.
It can also be defined as a control
established within an organization, originally concerned with the financial
records, investigative techniques developed by the control is now applied to
the analysis of the effectiveness of all parts of an entity’s operation and
management.
In any organization, the management
usually sets out the plans including control procedures while the internal
auditors supervise monitors and reviews as well as ensures compliance with such
plans and control procedures.
However, large organizations are
faced with various problems of co-ordination, control, public and employee
relationship and general management. The development and maintenance of
internal control system which is under the watchful eyes of internal audit
staff is therefore of great important in this regard.
Internal control system can be
defined as “a whole system of controls, financial and otherwise established by
the management in order to carry on the business of the enterprise in an
orderly and efficient manner, ensures adherence to management policies,
safeguard completeness and accuracy of the record.
An internal Auditor must be free to
review the whole internal control system of an organization. However, there is
a sharp distinction between internal and external auditing.
The Auditing Practice Committee (APC)
defined External Auditor’s duty as “Independent examination of and expression
of opinion on the financial statement of an enterprise by an appointed auditor
in the pursuance of that appointment and in compliance with any relevant
statutory obligation. While an Internal Auditor’s duty is to prevent and detect
errors and frauds by the management, the detection of frauds is only indicated
in the case of external Auditors.
For an effective internal auditing
program, the internal auditor must be independent; the independent of internal
auditing department is to be responsible to an officer of sufficient rank in
the organization to ensure a broad scope of activities and adequate
consideration of an effective action on the findings and recommendations made
by him. He should not develop and install procedures and prepare records which
he would not be expected to review and appraise.
1.2
STATEMENT OF PROBLEMS / PROBLEM
ANALYSIS
Over the years, doubts have been
expressed over the effectiveness of internal audit, in the Armed Forces. Some
of the factors responsible for internal audit ineffectiveness could be;
1.
Does
the ineffectiveness of internal audit result from shortage of professionally
qualified personnel?
2.
Is
the head of internal audit department independent? Is he responsible to the
assistant director or to the commander?
3.
Does
the account department prepare books on time so that the internal audit staff
can carry out post-payment auditing?
4.
Does
the management give prompt attention to the audit queries issued by the
internal audit department?
1.3
OBJECTIVE OF THE STUDY
In this research work, efforts are
made to find the root causes of the multi-various problems being encountered by
the internal audit department in the Armed Forces.
Intellectual universal remedy shall
be offered to, as the ineffectiveness of internal audit in the Armed Forces.
The central purpose of this research
work lies on the fact that an Internal Auditor is concerned with measuring and
evaluating the continuous effectiveness of the internal control system.
Therefore, if the internal audit department is reluctant, this may mean that;
a.
The
policies, plans and procedures set down by the management may not be complied
with by the organization’s staff
b.
The
information required by the management to make decision may be incomplete and
unreliable.
Recommendations shall be made as to
the way by which internal auditing can be effective so that it can make a
proper review of the operations, procedures and records of Nigeria Air Force’s
Pay and Accounting Group.
1.4
SIGNIFICANT OF THE STUDY
As this research work is being
carried out about the gap in human knowledge as regards the Nigeria Armed Force
accounting department and effectiveness of their internal control system.
At the end of this study, procedures
will be provided to follow and executed properly in order to make an end to
misappropriation, mismanagement of funds and as well fill in the gap in human
knowledge as it will also boost the morals of the forces personnel
1.5
SCOPE AND LIMITATION OF THE STUD
This research work shall be limited
to the Nigeria Air Force, Pay and Accounting Group alone which has been chosen
as a case study.
However, it will be practically
impossible to reach all the three arms of the Armed Forces in Nigeria in view
of this, effort shall be concentrated on Headquarters Pay and Accounting Group.
1.6
STATEMENT OF HYPOTHESIS &
RESEARCH QUESTIONS.
In order to make this research,
project a result oriented-one, the following hypothesis are developed
HYPOTHESIS I
H0: Poor
staffing is not responsible for the ineffectiveness of the internal audit
department in the Armed Forces.
H1: Poor
staffing is responsible for the ineffectiveness of internal audit department in
the Armed Forces.
HYPOTHESIS II
H0: Poor
accounting system and non-compliance to the accounting concept and convention
is not a barrier to effective Internal Audit in the Armed Forces.
H1: Poor
accounting system and non-compliance to the accounting concept and convention
is a barrier to effective Internal Audit in the Armed Forces.
HYPOTHESIS III
H0: Ignorance
of Internal auditors’ service and duties of prevention and detection of fraud
is not a barrier to the success and effectiveness of internal audit department
in the Armed.
H1: Ignorance
of Internal auditors’ service and duties of prevention and detection of fraud
is a barrier to the success and effectiveness of internal audit department in
the Armed.
HYPOTHESIS IV
H0: Engagement
of average skilled personnel instead of more professional personnel in the
Internal Audit Department do not amount to poor performance of the Internal
Audit Department of the Armed Force.
H1: Engagement
of average skilled personnel instead of more professional personnel in the
Internal Audit Department amounts to poor performance of the Internal Audit
Department of the Armed Force.
HYPOTHESIS V
H0: Non-Independent
(dependency) of the Head of Internal Audit Department is not responsible to
poor performance of the department.
H1: Non-Independent
(dependency) of the Head of Internal Audit Department is responsible to poor
performance of the department.
HYPOTHESIS VI
H0: Irregular/infrequent
auditing is not responsible for ineffectiveness of Internal Auditing in the
Armed Forces.
H1: Irregular/infrequent
auditing is responsible for ineffectiveness of Internal Auditing in the Armed
Forces.
HYPOTHESIS VII
H0: The
system of government practiced in Nigeria is not a limiting factor to
effectiveness of the audit department of the Armed Forces.
H1: The
system of government practiced in Nigeria is a limiting factor to
effectiveness of the audit department of the Armed Forces.
1.7
DEFINITION OF TERMS
Definition of terms relevant to this
research study is given below:
COMPLIANCE TEST
These are test designed to ensure
that the internal controls on which the auditor wish to rely on are working
properly in practice. An internal auditor should carry out compliance test on
which he wishes to rely on, are functioning effectively throughout the period.
If compliance test disclose no
exceptions, the auditor may reasonably place reliance on the effective
functioning of the internal control test.
SUBSTANTIVE TEST
These are test which seek direct
evidence of the correct treatment of a transaction, a balance, an asset, a
liability on any item in the books or the accounts. In other words, they are
tests of transactions and balances and other procedures such as analytical
review, which seek to provide audit evidence as to the completeness, accuracy
and validity of the information contained in the accounting records or in the
financial statements. For example, to test a balance in a deposit account,
direct confirmation must be obtained from the bank.
INVESTIGATION
This is when audit staff are not
asked to report on special situation to managements. The basis and scope of
investigation can be incorrect with a proposed purchase of a business,
suspected fraud or of a back advancing credit or in a number of other
situations.
AUDIT PROGRAMME
This is the over all plan or work
which an internal auditor intends to follow in his attempt to gather sufficient
evidence to permit him to offer an informal opinion. It is both the summary of
all that must be done before he will be satisfied that all aspects of the
financial data have been investigated and also a list of detailed instructions
to his assistance.
Audit program provides a guide in
arranging and distributing the work and a check against the possibility of
omissions. It facilitates controls and review by managers and supervisions and
provide a record of works done.
PRE-AUDIT
This is referred to as, pre-payment
audit. It is the examination of transactions before payment. It may include an
examination of contracts prior to arrival, scrutinizing of all vouchers before
payment and review of all cheques before payment.
Pre-audit provides that;
1.
Expenditures
are not upon their face unreasonable or extravagant.
2.
Sufficient
frauds are available for enablement of the voucher.
3.
There
has been compliance with budgetary, civil service, legislative and legal
requirements.
PORT AUDIT
This is sometimes referred as post
payment audit, it represents an after the fact examination. Hitherto, post
audit was concerned primarily with control of cash and the verification of
revenues. Today, its general scope involves the review and appraisal of overall
performance measured against established goals.
1.8
HISTORICAL BACKGROUND
THE NIGERIA AIR FORCE (NAF)
The idea of establishing of an Air
Force for Nigeria was first mooted in 1961 following the Nation’s participation
in peace-making operation in Congo and Tanganyika (now Tanzania), during the
peace-keeping operation, foreign air forces were employed to air-lift the
Nigeria Army Regiment to and fro the theaters of operations. The Nigeria
government at the time, no doubt recognized the urgent need to establish an air
force activity supported by modern facilities to provide full complement of
forces to enhance the nation’s military positively. Early in 1962, the
government agreed in principle that the NAF be established. Parliament
therefore approved the establishment of the NAF and recruitment of cadets
commenced in June 1962.
Consequently, the NAF was officially
established by the statutory Act of Parliament in April 1964 to serve four (4)
main purposes, namely;
1.
To
achieve a full complement of the military defense system of the Federal
Republic of Nigeria both in the air and on the ground.
2.
To
ensure a fast versatile mobility of the Armed Forces.
3.
To
provide close support for the ground-based and seaborne Forces in all phases of
operations and to ensure the territorial integrity of a united Nigeria.
4.
To
give the country the deserved prestige this is invaluable in the international
matters.
Following the expansion of the NAF
over time and the need to enforce all international law convention relating to
space activities in the Nigeria airspace, the Federal government promulgated
Decree 105 (Armed Forces Amendment Decree of 23rd August 1994) which
provided additional roles which includes;
a.
Enforcing
and assisting in coordinating the enforcement of international law conventions
practices and customs ascribed and acceded to by Nigeria airspace.
b.
Coordinating
and enforcing all national and international air laws acceded or ascribed to by
Nigeria
airspace.
c.
Delineating,
demarcating and coordinating all aerial surveys and security zones of the Nigeria
airspace.
It was in 1962 that the drive for the
required manpower for the planned force started. Simultaneously with this
development, government in dialogue with source friendly nations on the
possibility of training Nigeria Air Force personnel in various specialist
fields.
The first batches of 10 cadets were
enlisted in 1962 to undergo training with the Ethiopian Air force. The second
set of 16 cadets was enlisted in February 1963 to undergo training with the
Royal Canadian Air force. The stage was set for the training of its personnel
in country. Consequently, several countries were approved but the lot fell on
the German Air force to provide technical assistance for the local training of
NAF personnel and this materialized in 1963.
The Nigerian Air Force is currently made up of three commands namely;
1.
Tactical
Air Command
2.
Training
Command
3.
Logistic
Command
The tactical command was established
for the purpose of centralizing of command with a view to providing joint
operation doctrine for the use of the tactical forces. The training command on
its own was established for the purpose of planning and coordinating the
administrative and operational command of all training activities in the NAF
while the logistic command was established to supply and maintain all the
operational equipment as well as infrastructural facilities required for the
effective accomplishment of NAF assigned tasks.
In addition to the three major
commands, there are some other formations which are directly answerable to HQ
NAF. These are the Pay and Accounting Group, personnel management center and
the aero medical centre.
THE NIGERIAN ARMY (NA)
The Nigerian Army has the largest
recorded history among the three components of the Nigeria Armed Forces. The
force emerged out of the West African Frontier Forcer (WAFF) years after
undergoing transformation such as Nigerian soldiers immense participation in
series of peace-keeping operations; the 4th August 1914 war that
involved Great Britain and by extension its overseas territories and throughout
the duration of the war, Nigeria was contacted to make sacrifices wither in
fighting soldiers or as agricultural produce for the sustenance of the Britain
war effort and the Britain economy. Many Britain officials joined the
imperial force, West African Frontier Force (WAFF)
The incident which started the was
occurs at Sarajevo, the capital of Bosnia, on the 28th June 1914
following the assassination of Archduke Ferdinand the heir to the Australian
throne and his wife by a Bosnian student. The Serbian were held responsible for
the murderer.
On 3rd July 1914, the Australian
government sent an ultimatum to the Serbian government demanding a satisfactory
answer within forty-eight hours. Serbian accepted other conditions given by the
Austria
but refused to allow Austrian police in the Serbian territory to enforce the
Austrian on Serbian. On the
28th July, 1914, Austria declared war on Serbian. On
the outbreak of war between Austria
and Serbian, Russia
mobilized her troops in favour of Serbian; German declared was on Russia on the 1st August 1914
when he demand for the withdrawal of Russia force was not headed to. Germany also
declared war on France
when she refuses to give a guarantee of her neutrality. In August 1914, Great Britain
declared war on German when German force invaded Belgium in complete defiance of the
treaty of 1839 which guaranty the neutrality of Belgium. The entry into the war by Britain on the
side of the Allied Forces brought all her colonies into world war.
Nigeria soldiers distinguished themselves in
many of the campaigns in Cameroon’s
and the East Africa.
It was after the transformation and
others from 1863 when the British government of Lagos Lt. Glover of the Royal
Navy organized 18 Northern Nigerian’s into a small local force to positive
expedition in the Lagos hinterland and to protect British trade routes around
Lagos. The force was expanded to perform both police and military duties for
the colonial government. They existed in constabularies with slightly deferring
emphasis, these constabularies were to keep internal peace in the newly annexed
colonies to ensure the flourishing of legitimate trade and for suppressing the
then dwindling slave trade.
In 1897, the idea of a West African
Frontier Force (WAFF) was received and fully established. The amalgamation of
the Northern and Southern protectorate in 1914 by Lord Lugard, all the native
forces in Nigeria
were unified and named Nigerian Regiment. By 1956, it was renamed the Queen’s
own Nigerian Regiment (QONR). In the same year, WAFF became regionalized and
each military force became independent of the others. As a result of this
development, the Nigerian Regiment became the Nigerian Military Force (NMF).
When Nigerian became independent in 1960, the NMF was renamed the Royal
Nigerian Army (RNA), this was again changed to the Nigerian Army in 1963,
following the attainment by the country of her republican status. The decade
between 1955 and 1965 witnessed a lot of the force; some Nigerians were
commissioned officers in the NA after having undergone officer cadet training
usually in the military institution in Tashi Abana, Mous Cadet College
Aldershot and the Royal Military Academy Sand Hurst, England.
In 1959, the Nigerian Military
training college at Kaduna
was established for the training of other ranks. It became the potential source
of securing officers, NCO’s and technician for the army. Also during the period
1955-1966, the Nigeria Army participated in a number of peace-keeping
operations in 1960 and 1964 respectively. The outbreak of civil war in 1967 in Nigeria was
another milestone as well as turning point in the history of Nigeria Army.
However, the Nigeria Army is never
idle since the end of the civil war, it has engaged regularly in UN
peace-keeping operations such as the UNIFIL in Lebanon, UBNPROFOR in Yugoslavia,
Uunosomin Somalia
and further served as members of observers team in Iraq /Iraq, Uganda / Rwanda, Angola/Kuwait among others.
The beginning of the 90’s has seen Nigeria Army as a force to reckon with both
peace-keeping and peace enforcement operations in different parts of the world.
It has formed the backbone of the
ECOWAS Peace Monitoring Group (ECOMOG) deployed to quell the crises in Liberia while
in Rwanda;
it is part of the UNAMIR. At home apart from efficiently standing as a
deterrent force against eternal attacks such as the situation in Bakassi
Peninsular.
THE NIGERIA NAVY
The Nigeria Navy came into existence
in 1958. on 26th
March 1958, the House of Representatives approved the establishment
of the Navy, it was initially called the Nigeria Naval Force. It was created
out of a former quasi-military force which was known as the Nigeria Marine and
which was under the ministry of transport for maritime policing duties.
The authorization of the Nigeria Navy
as a branch of the Armed Forces in 1958 came as part of the pre-independence
Nigerian nationalism which demanded that Nigeria ought to be an independent
nation state and have corresponding independent Armed forces to defend its
sovereignty and to protect its economic resources. That was the year the name Nigeria Naval
Force was changed to the Royal Nigerian Navy (RNN).
On its creation, as a Naval force in
1956, only 11(eleven) assorted boasts and harbour crafts and about 200 officers
and men were transferred to it by the defunct Nigerian Marine.
On Nigeria’s attainment of Republican
states in 1963, the word “Royal” was dropped. The Navy Act passed in 1964
removed the limitation of the Nigeria Navy to the country’s territorial waters
by assigning to it the following roles:
a.
Naval
defense of Nigeria
b.
Assisting
in the enforcement of the custom laws of Nigeria.
c.
Making
Hydrographic surveys.
d.
Training
in Naval duties.
e.
Such
other duties as the council of ministers may from time to time direct.
There are three main commands in the
Nigeria Navy today; the Western and Eastern Naval command are the two
operational commands with Headquarters at Apapa and Calabar respectively while
the third command is the Naval training command. To meet the roles, the Nigeria
Navy concept of operations remains the total commitment to protect the economic
life wire of the country by organizing to arrest economic sabotage and other
forms of illegalities in out waters.
Secondly, is the determination of
deter-external aggressions in West Africa
sub-region and Africa in general. For the
future, the Nigeria Army is looking forward to improving its sealift capability
so that it can launch the Army from the seaboard when the need arises,
improving the capability in the name of sub-marine.
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