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Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives

Mohammed, Shafiu ; Souares, Aurélia ; Bermejo, Justo Lorenzo ; Sauerborn, Rainer ; Dong, Hengjin

In: BMC health services research, 14 (2014), Nr. 127. pp. 1-12. ISSN 1472-6963

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Abstract

Background: Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines possible factors that influence each domain, according to providers’ perspectives. Methods: A retrospective, cross-sectional survey was done between August and December 2010 in Kaduna state, and 466 health care provider personnel were interviewed. Optimal-resource-use was defined in four domains: provider payment mechanism (capitation and fee-for-service payment methods), benefit package, administrative efficiency, and active monitoring mechanism. Logistic regression analysis was used to identify provider factors that may influence each domain. Results: In the provider payment mechanism domain, capitation payment method (95%) performed better than fee-for-service payment method (62%). Benefit package domain performed strongly (97%), while active monitoring mechanism performed weakly (37%). In the administrative efficiency domain, both promptness of referral system (80%) and prompt arrival of funds (93%) performed well. At the individual level, providers with fewer enrolees encountered difficulties with reimbursement. Other factors significantly influenced each of the optimal-resource-use domains. Conclusions: Fee-for-service payment method and claims review, in the provider payment and active monitoring mechanisms, respectively, performed weakly according to the providers’ (at individual-level) perspectives. A short-fall on the supply-side of health insurance could lead to a direct or indirect adverse effect on the demand-side of the scheme. Capitation payment per enrolees should be revised to conform to economic circumstances. Performance indicators and providers’ characteristics and experiences associated with resource use can assist policy makers to monitor and evaluate health insurance implementation.

Item Type: Article
Journal or Publication Title: BMC health services research
Volume: 14
Number: 127
Publisher: BioMed Central
Place of Publication: London
Date Deposited: 01 Dec 2015 14:15
Date: 2014
ISSN: 1472-6963
Page Range: pp. 1-12
Faculties / Institutes: Medizinische Fakultät Heidelberg > Institut für Medizinische Biometrie und Informatik
Medizinische Fakultät Heidelberg > Institut für Public Health (IPH)
Subjects: 300 Social sciences
610 Medical sciences Medicine
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