eprintid: 19372
rev_number: 47
eprint_status: archive
userid: 1589
dir: disk0/00/01/93/72
datestamp: 2015-12-01 14:15:22
lastmod: 2022-07-18 01:24:19
status_changed: 2015-12-01 14:15:22
type: article
metadata_visibility: show
creators_name: Mohammed, Shafiu
creators_name: Souares, Aurélia
creators_name: Bermejo, Justo Lorenzo
creators_name: Sauerborn, Rainer
creators_name: Dong, Hengjin
title: Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives
subjects: ddc-300
subjects: ddc-610
divisions: i-911800
divisions: i-912800
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.  
date: 2014
publisher: BioMed Central
id_scheme: DOI
ppn_swb: 1656046024
own_urn: urn:nbn:de:bsz:16-heidok-193720
language: eng
bibsort: MOHAMMEDSHPERFORMANC2014
full_text_status: public
publication: BMC health services research
volume: 14
number: 127
place_of_pub: London
pagerange: 1-12
issn: 1472-6963
citation:   Mohammed, Shafiu ; Souares, Aurélia ; Bermejo, Justo Lorenzo ; Sauerborn, Rainer ; Dong, Hengjin  (2014) Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives.  BMC health services research, 14 (127).  pp. 1-12.  ISSN 1472-6963     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/19372/1/12913_2012_Article_3747.pdf