Modeling Healthcare Cost for National Health Insurance Scheme: Experiential Analysis From Health Management Organisations in Nigeria

Abstract

Healthcare costs in Nigeria have been rising faster than general inflation for many years unlike the growth of health insurance in Ghana and South Africa which was almost hitch free. Nigeria has had many challenges in her health sector. We are in the midst of unprecedented revolution in healthcare hence the need to tame runaway cost-inflation as it is spawning new incentives and payment structure which is democratizing data and empowering consumers. This study explores healthcare utilization data in determining future claims that each enrollee of the Health Maintenance Organizations (HMOs) is entitled to. The data which is made up of 2538 enrollees of the NHIS were analyzed using the Generalized Linear Models (GLM). This model is used to check the significance of the co-variates (age, sex and diagnosis). The results show the age, sex and diagnosis are significant predictors of healthcare costs. It is recommended that healthcare providers and policy makers should take into consideration the effects of these variables as they determine how high or low healthcare costs should be.