Study Data from University of Nigeria Provide New Insights into Health Insurance (Do beneficiaries’ views matter in healthcare purchasing decisions?…

Managed Care Weekly Digest

Study Data from University of Nigeria Provide New Insights into Health Insurance (Do beneficiaries' views matter in healthcare purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health ...)

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- Researchers detail new data in Health Insurance. According to news originating from Enugu, Nigeria, by NewsRx correspondents, research stated, "Purchasing is a health financing function that involves the transfer of pooled resources to providers on behalf of a covered population. Little attention has been paid to the extent to which the views of that population are reflected in purchasing decisions."

Our news journalists obtained a quote from the research from the University of Nigeria, "This article explores how purchasers in two financing mechanisms: the Formal Sector Social Health Insurance Programme (FSSHIP) operating under the Nigerian National Health Insurance Scheme (NHIS), and the tax-funded health system perform their roles in light of their responsibilities to the populations. A case study approach was adopted in which each financing mechanism is a case. Sixteen (16) in-depth interviews with purchasers and eight (8) focus group discussions with beneficiaries were held. Agency and organizational behavioural theories were used to characterise the purchaser-citizen relationships. A deductive framework approach was used to assess whether actions identified in a model of 'ideal' strategic purchasing actions were undertaken in each case. For both cases, mechanisms exist to reflect people's health needs in purchasing decisions, including quantitative and qualitative needs assessment, mechanisms to raise awareness of benefit entitlements and allow choice. However, purchasers do not use the mechanisms to effectively engage with and hold themselves accountable to the people. In the tax-funded system, weak information systems and unclear communication channels between the purchaser and citizens constrain assessment of needs; while timeliness of health information and poor engagement practices of Health Maintenance Organisations (HMOs) are the main constraints in FSSHIP. Inadequate information sharing in both mechanisms limits beneficiaries' awareness of entitlements. Although beneficiaries of FSSHIP can choose providers, lack of information on the quality of services offered by providers constrains rational decision-making and the inability to change HMOs reduces HMO responsiveness to beneficiary needs. Responsiveness and accountability to beneficiaries are undervalued by purchasers in both financing mechanisms. In the tax-funded system, civil society organisations can facilitate engagement and accountability of purchasers and the people. In FSSHIP, NHIS needs to provide stronger stewardship of HMOs to promote effective engagement with members."

According to the news editors, the research concluded: "Furthermore, the NHIS should introduce mechanisms that allow FSSHIP members to choose their own HMO, which could encourage HMOs to be more responsive to members."

For more information on this research see: Do beneficiaries' views matter in healthcare purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health insurance program of the National Health Insurance Scheme. International Journal for Equity in Health, 2017;16():1-11. International Journal for Equity in Health can be contacted at: Biomed Central Ltd, 236 Grays Inn Rd, Floor 6, London WC1X 8HL, England. (BioMed Central - www.biomedcentral.com/; International Journal for Equity in Health - www.equityhealthj.com)

The news correspondents report that additional information may be obtained from O. Ibe, University of Nigeria, Coll Med, Hlth Policy Res Grp, Enugu, Nigeria. Additional authors for this research include A. Honda, E. Etiaba, N. Ezumah, K. Hanson and O. Onwujekwe (see also Health Insurance).

Keywords for this news article include: Enugu, Nigeria, Africa, Insurance Companies, Health and Medicine, Health Insurance, University of Nigeria.