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Open Access Research article

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

Shafiu Mohammed14, Aurélia Souares1, Justo Lorenzo Bermejo2, Rainer Sauerborn1 and Hengjin Dong13*

Author Affiliations

1 Institute of Public Health, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany

2 Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany

3 Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, P.R. China

4 Ahmadu Bello University, Zaria, Nigeria

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BMC Health Services Research 2014, 14:127  doi:10.1186/1472-6963-14-127

Published: 14 March 2014

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.

Keywords:
Health insurance; Health care providers; Optimal resource use; Nigeria; Performance