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.

scholarly journals The Role of Trust in the Pattern of Enrolment to a Social Health Insurance Scheme and Distribution of Healthcare Facilities in Ibadan, Southwest, Nigeria

2021 ◽  
Author(s):  
David Ayobami Adewole ◽  
Steve Reid ◽  
Tolu Oni
Keyword(s):  
Health Insurance ◽  
Healthcare Providers ◽  
Social Health Insurance ◽  
Healthcare Services ◽  
Health Insurance Scheme ◽  
Skewed Distribution ◽  
Insurance Scheme ◽  
Quality Healthcare ◽  
Healthcare Facilities ◽  
Southwest Nigeria

The National Health Insurance Scheme (NHIS) of Nigeria established in the year 2005 aims to minimize the inequity of access to quality healthcare services in Nigeria. As of the year 2017, enrolment in NHIS-accredited facilities in the southwest region of Nigeria was significantly clustered, with more than three-quarters of NHIS enrollees registered with only 10% of the available NHIS-accredited facilities in the six states of the region. This study explored the factors associated with the skewed distribution of enrollees across facilities and the influence of stakeholders. This is a descriptive, qualitative, case study design among stakeholders of the NHIS in Ibadan, Oyo State, Southwest, Nigeria. In-depth interviews were conducted between March and June, 2019, with all selected individual stakeholders as listed earlier. Data analysis was done using an inductive thematic approach. Across the board, there was a low level of trust in government and government policies among healthcare providers and enrollees. Few healthcare providers were willing to render services under the scheme at inception. The majority of the enrollees were compelled to register with the few available healthcare providers. Among the enrollees, a few personally chose healthcare facilities and providers that were perceived to render better quality services to receive care. Priority should be given to building trust among stakeholders in the NHIS as this would facilitate cooperation and better working relationship, and reposition the scheme for better performance.

scholarly journals Is value-based payment for healthcare feasible under Ghana’s National Health Insurance Scheme?

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yussif Issahaku ◽  
Andrea Thoumi ◽  
Gilbert Abotisem Abiiro ◽  
Osondu Ogbouji ◽  
Justice Nonvignon
Keyword(s):  
Quality Of Care ◽  
Health Insurance ◽  
Health System ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Healthcare Providers ◽  
Health Insurance Scheme ◽  
Insurance Scheme

Abstract Background Effective payment mechanisms for healthcare are critical to the quality of care and the efficiency and responsiveness of health systems to meet specific population health needs. Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has adopted fee-for-service, diagnostic-related groups and capitation methods, which have contributed to provider reimbursement delays, rising costs and poor quality of care rendered to the scheme’s clients. The aim of this study was to explore stakeholder perceptions of the feasibility of value-based payment (VBP) for healthcare in Ghana. Value-based payment refers to a system whereby healthcare providers are paid for the value of services rendered to patients instead of the volume of services. Methods This study employed a cross-sectional qualitative design. National-level stakeholders were purposively selected for in-depth interviews. The participants included policy-makers (n = 4), implementers (n = 5), public health insurers (n = 3), public and private healthcare providers (n = 7) and civil society organization officers (n = 1). Interviews were audio-recorded and transcribed. Data analysis was performed using both deductive and inductive thematic analysis. The data were analysed using QSR NVivo 12 software. Results Generally, participants perceived VBP to be feasible if certain supporting systems were in place and potential implementation constraints were addressed. Although the concept of VBP was widely accepted, study participants reported that efficient resource management, provider motivation incentives and community empowerment were required to align VBP to the Ghanaian context. Weak electronic information systems and underdeveloped healthcare infrastructure were seen as challenges to the integration of VBP into the Ghanaian health system. Therefore, improvement of existing systems beyond healthcare, including public education, politics, data, finance, regulation, planning, infrastructure and stakeholder attitudes towards VBP, will affect the overall feasibility of VBP in Ghana. Conclusion Value-based payment could be a feasible policy option for the NHIS in Ghana if potential implementation challenges such as limited financial and human resources and underdeveloped health system infrastructure are addressed. Governmental support and provider capacity-building are therefore essential for VBP implementation in Ghana. Future feasibility and acceptability studies will need to consider community and patient perspectives.

scholarly journals Mixed and Multi-Methods Protocol to Evaluate Implementation Processes and Early Effects of the Pradhan Mantri Jan Arogya Yojana Scheme in Seven Indian States

2020 ◽  
Vol 17 (21) ◽  
pp. 7812
Author(s):  
Manuela De Allegri ◽  
Swati Srivastava ◽  
Christoph Strupat ◽  
Stephan Brenner ◽  
Divya Parmar ◽  
...  
Keyword(s):  
Health Insurance ◽  
Healthcare Providers ◽  
Unmet Need ◽  
Health Insurance Scheme ◽  
Financial Protection ◽  
Insurance Scheme ◽  
Indian States ◽  
Implementation Processes ◽  
Process Documentation ◽  
Early Effects

In September 2018, India launched Pradhan Mantri Jan Arogya Yojana (PM-JAY), a nationally implemented government-funded health insurance scheme to improve access to quality inpatient care, increase financial protection, and reduce unmet need for the most vulnerable population groups. This protocol describes the methodology adopted to evaluate implementation processes and early effects of PM-JAY in seven Indian states. The study adopts a mixed and multi-methods concurrent triangulation design including three components: 1. demand-side household study, including a structured survey and qualitative elements, to quantify and understand PM-JAY reach and its effect on insurance awareness, health service utilization, and financial protection; 2. supply-side hospital-based survey encompassing both quantitative and qualitative elements to assess the effect of PM-JAY on quality of service delivery and to explore healthcare providers’ experiences with scheme implementation; and 3. process documentation to examine implementation processes in selected states transitioning from either no or prior health insurance to PM-JAY. Descriptive statistics and quasi-experimental methods will be used to analyze quantitative data, while thematic analysis will be used to analyze qualitative data. The study design presented represents the first effort to jointly evaluate implementation processes and early effects of the largest government-funded health insurance scheme ever launched in India.

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