Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria

Abstract

BackgroundNigeria contributes only 2% to the world’s population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring.ObjectiveThe purpose of this study was to document costs associated with a mobile technology–supported, community-based health insurance scheme.MethodsThis analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent.ResultsAll the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations and a telecom operator revealed high investment interests. Cost documentation analysis of income versus expenditure for the major maternal and child health service areas—antenatal care, routine immunization, and birth attendance for 1 year—showed that primary health facilities would still profit if technology-supported, health insurance schemes were adopted.ConclusionsThis study demonstrates a case for the implementation of enrolment, encounter management, treatment verification, claims management and reimbursement using mobile technology for health insurance in Abuja, Nigeria. Available data show that the introduction of an electronic job aid improved efficiency. Although it is difficult to make a concrete statement on profitability of this venture but the interest of the health maintenance organizations and telecom experts in this endeavor provides a positive lead.

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

“…This infers that health insurance uptake by unemployed persons in the informal sector is likely to be considerably lower, with over 30% of the study population likely be involved in menial jobs in the informal sector. Health insurance is mostly subscribed to by government employees [79][80][81][82][83].…”

The Lancet Nigeria Commission: investing in health and the future of the nation

“…237 Private health insurance schemes often do not cover individuals most in need, although they can be a useful stopgap before sufficient public provision is secured. Encouraging the use of mobile payments and apps to make and process insurance claims could reduce barriers to insurance coverage for some individuals, especially in urban areas, 238 however, the larger barrier is poverty, meaning insufficient total premiums can be pooled to fund sufficient services for individuals most in need. 239 The funding gap for the National Strategic Health Development Plan 2 2018-2022 moderate coverage scenario ($6•8 billion of a total estimated cost of $19•9 billion) could have been bridged via increasing state health insurance subscribers from 5% in 2018 to 30% in 2022, 11 however the subscriber base remained low at 5% in 2020.…”

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

“…Another vital element is the development of funding options for digital therapeutics during and after the research phase (eg, innovation and research grants, pay-for-performance constructs, or payment/completed digital therapeutic use cycle). For the latter, it is important that the financial responsibility is not placed on patients to protect them from disproportionate out-of-pocket payments and ensure that digital therapeutics do not become an exclusive domain of higher socioeconomic groups [ 12 , 15 , 46 , 58 , 61 , 72 , 86 , 99 , 100 , 105 , 106 , 114 , 116 , 146 , 149 , 154 , 164 , 172 , 190 , 192 , 197 , 200 , 202 , 226 - 228 , 249 ]. It was emphasized that there were benefits to allowing the procurement of digital therapeutics as locally as possible, as health purchasers (eg, Integrated Care Boards in the United Kingdom, insurance companies in the Netherlands, and employer groups in the United States) are best placed to assess the needs and preferences of their covered population, although this could translate into longer adoption times and higher uptake costs, as each individual insurer needs to invest in the digital infrastructure.…”

“…Our search strategy yielded 49,192 1). Out of 244 documents, our final sample comprised 60 (24.6%) literature reviews [19,; 49 (20.1%) viewpoints, commentaries, and editorials [11,13,17,; 43 (17.6%) cross-sectional studies [83,; 39 (16%) qualitative research articles [1,15,; 13 (5.3%) case reports [4,5,12,[224][225][226][227][228][229][230][231][232][233]; 11 (4.5%) longitudinal studies [234][235][236][237][238][239][240][241][242][243][244]; 9 (3.7%) mixed methods studies [245][246][247][248][249][250][251][252][253]; 5 (2%) economic evaluations [254][255][256][257][258]; ...…”