scholarly journals Correction to: Translating Research to Policy: Setting Provider Payment Rates for Strategic Purchasing under India’s National Publicly Financed Health Insurance Scheme

2021 ◽  
Author(s):  
Shankar Prinja ◽  
◽  
Maninder Pal Singh ◽  
Kavitha Rajsekar ◽  
Oshima Sachin ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Strategic Purchasing ◽  
Provider Payment ◽  
Research To Policy ◽  
Policy Setting

scholarly journals Strategic purchasing for universal health coverage: examining the purchaser–provider relationship within a social health insurance scheme in Nigeria

2018 ◽  
Vol 3 (5) ◽  
pp. e000917 ◽  
Author(s):  
Enyi Etiaba ◽  
Obinna Onwujekwe ◽  
Ayako Honda ◽  
Ogochukwu Ibe ◽  
Benjamin Uzochukwu ◽  
...  
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Healthcare Providers ◽  
Social Health Insurance ◽  
Health Insurance Scheme ◽  
Social Health ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Strategic Purchasing ◽  
Universal Health

BackgroundIn an attempt to achieve universal health coverage, Nigeria introduced a number of health insurance schemes. One of them, the Formal Sector Social Health Insurance Programme (FSSHIP), was launched in 2005 to provide health cover to federal government and formal private sector employees. It operates with two levels of purchasers, the National Health Insurance Scheme (NHIS) and health maintenance organisations (HMOs). This study critically assesses purchasing arrangements between NHIS, HMOs and healthcare providers and determines how the arrangements function from a strategic purchasing perspective within the FSSHIP.MethodsA qualitative study undertaken in Enugu state, Nigeria, data were gathered through reviews of documents, 17 in-depth interviews (IDIs) with NHIS, HMOs and healthcare providers and two focus group discussions (FGDs) with FSSHIP enrolees. A strategic purchasing lens was used to guide data analysis.ResultsThe purchasing function was not being used strategically to influence provider behaviour and improve efficiency and quality in healthcare service delivery. For the purchaser–provider relationship, these actions are: accreditation of healthcare providers; monitoring of HMOs and healthcare providers and use of appropriate provider payment mechanisms for healthcare services at every level. The government lacks resources and political will to perform their stewardship role while provider dissatisfaction with payments and reimbursements adversely affected service provision to enrolled members. Underlying this inability to purchase, health services strategically is the two-tiered purchasing mechanism wherein NHIS is not adequately exercising its stewardship role to monitor and guide HMOs to fulfil their roles and responsibilities as purchasing administrators.ConclusionsPurchasing under the FSSHIP is more passive than strategic. Governance framework requires strengthening and clarity for optimal implementation so as to ensure that both levels of purchasers undertake strategic purchasing actions. Additional strengthening of NHIS is needed for it to have capacity to play its stewardship role in the FSSHIP.

scholarly journals Determinants and perception of health insurance participation among healthcare providers in Nigeria: A mixed-methods study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255206
Author(s):  
Hezekiah Olayinka Shobiye ◽  
Ibironke Dada ◽  
Njide Ndili ◽  
Emmanuella Zamba ◽  
Frank Feeley ◽  
...  
Keyword(s):  
Health Insurance ◽  
Mixed Methods ◽  
Financial Management ◽  
Healthcare Providers ◽  
Health Insurance Scheme ◽  
Patient Volume ◽  
State Health ◽  
Insurance Scheme ◽  
Provider Payment ◽  
Lagos State

Background To accelerate universal health coverage, Nigeria’s National Health Insurance Scheme (NHIS) decentralized the implementation of government health insurance to the individual states in 2014. Lagos is one of the states that passed a State Health Insurance Scheme into law, in order to expand the benefits of health insurance beyond the few residents enrolled in community-based health insurance programs, commercial private health insurance plans or the NHIS. Public and private healthcare providers are a critical component of the Lagos State Health Scheme (LSHS) rollout. This study explored the determinants and perception of provider participation in health insurance programs including the LSHS. Methods This study used a mixed-methods cross sectional design. Quantitative data were collected from 60 healthcare facilities representatively sampled from 6 Local Government Areas in Lagos state. For the qualitative data, providers were interviewed using structured questionnaires on selected characteristics of each health facility in addition to the managers’ opinions about the challenges and benefits of insurance participation, capacity pressure, resource availability and financial management consequences. Results A higher proportion of provider facilities participating in insurance relative to non-participating facilities were larger with mid to (very) high patient volume, workforce, and longer years of operation. In addition, a greater proportion of private facilities compared to public facilities participated in insurance. Furthermore, a higher proportion of secondary and tertiary facilities relative to primary facilities participated in insurance. Lastly, increase in patient volume and revenue were motivating factors for provider facilities to participate in insurance, while low tariffs, delay and denial of payments, and patients’ unrealistic expectations were mentioned as inhibiting factors. Conclusion For the Lagos state and other government insurance schemes in developing countries to be successful, effective contracting and quality assurance of healthcare providers are essential. The health facilities indicated that these would require adequate and regular provider payment, investments in infrastructure upgrades and educating the public about insurance benefit plans and service expectations.

PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

2015 ◽  
pp. 89-95
Author(s):  
Thi Hoai Thuong Nguyen ◽  
Hoang Lan Nguyen ◽  
Mau Duyen Nguyen
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Factors Affecting ◽  
The People ◽  
Universal Health Insurance Coverage ◽  
The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

scholarly journals Factors Affecting Utilization of the National Health Insurance Scheme by Federal Civil Servants in Rivers State, Nigeria

2021 ◽  
Vol 58 ◽  
pp. 004695802110176
Author(s):  
Obelebra Adebiyi ◽  
Foluke Olukemi Adeniji
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Workers ◽  
Civil Servants ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Rivers State

The National Health Insurance Scheme (NHIS) of Nigeria was established in 2005. This study assessed the utilization of health care and associated factors amongst the federal civil servants using the NHIS in Rivers state. This was a descriptive cross-sectional study using self-administered questionnaires. Data were collated and analyzed using SPSS version 21.0. A Chi-square test was carried out. The level of Confidence was set at 95%, and the P-value ≤ .05. Out of a total of 334 respondents, 280 (83.8%) were enrolled for NHIS, 203 (72.5%) utilized the services of the scheme. Most 181 (82.1%) of the respondents who utilized visited the facility at least once in the preceding year. Although, 123 (43.9%) of the respondents made payments at a point of access to health care services, overall there was a reduction in out of pocket payment. Possession of NHIS card, the attitude of health workers, and patients’ satisfaction were found to significantly affect utilization P ≤ .05. Regression analysis shows age and income to be a predictor of utilization of the NHIS. Though utilization is high, effort should be made to remove payment at the point of access and improving the harsh attitude of some of the health workers.

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