Universal Healthcare and Access to the Lower-Income Population
An Exploration of Capitation in Lagos, Nigeria
by
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Many in Nigeria seem to overlook the fact that the increased productivity of a Nation lies with the population’s health. There is a continuing gap between the Nigerian government’s efforts to provide affordable healthcare access to all its citizens and the inability of the NHIS to reach the lower-income population, with a focus on disease prevention. The World Health Organization’s strategy to ensure quick access to disease outbreaks is tied to healthcare access to the entire population and a comprehensive and efficient disease surveillance system. A direct capitation payment to healthcare providers will cut through the resistance currently seen with private outpatient medical centers in Nigeria and dramatically increase participation in the universal healthcare scheme. Furthermore, incentivizing healthcare providers to locate in suburban locations may increase access to the general population. This research study provides a geospatial-based analysis that shows the current condition of private outpatient medical centers, which typically concentrate in more affluent urban areas under a fee-for-service model.
This research provides an alternative method of successfully delivering healthcare to the impoverished populations in Nigeria and many developing economies in the world. The direct capitation payment model will bypass the Health Maintenance Organization (HMO), who are the catalysts for resistance seen with private outpatient medical centers. They do not want to enter into a contract with the HMOs who do not pay on time or as agreed based on interviews with primary care physicians in Nigeria. The HMOs can be repurposed to provide performance monitoring, quality control, and technical support to the private outpatient clinics.
Triangulation of data from the USAID Census of private outpatient medical centers, data from the audited report of the 2016 Lagos State Bureau of Statistics at the Lagos State Ministry of Economic Planning and Budget, containing population demographics, revenues, reported diseases (Malaria, HIV/AIDS, and Tuberculosis), and landmass, among other population statistics to produce various characteristics of the clinic locations and notable disease prevalence in the areas. The study also included data from the National Health Insurance Scheme list of HMOs in Lagos, Nigeria. The incorporation of these data sets into a geospatial map layered onto the Lagos boundary and local government area (LGA) shapefiles produced an incredible view of the epidemiological state of Lagos. The USAID Census data included details about each medical center, such as the number of physicians, nurses, technicians, pharmacists, average visits, longitudinal and latitudinal decimal degrees pointing to the location of each private medical center.
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About the Book
This book presents a research-based exploration of Universal Healthcare and the benefits of healthcare providers’ capitation payment method in many developing economies. The author begins the research study by describing the history of healthcare in Nigeria and exposes a country’s healthcare problem that must be addressed to ensure healthcare access to the low-income population. The book leads the reader through perspectives on the major world’s healthcare payment systems, which include (a) diagnosis-related group (DRG); (b) pay-for-performance (P4P); (c) global budgeting payment systems; (d) fee-for-service (FFS) payment system; and (e) a provider-based capitation payment (PBCP) system. The author provides further review on the advent of geospatial mapping and healthcare, PBCP in lower- and middle-income countries (LMIC), and the current conditions at private outpatient medical centers (POMC) in Lagos, Nigeria. The study’s qualitative approach called for an inductive and deductive data analysis, with a bottom-up approach to building patterns and a comprehensive set of themes. To visualize the results of the predominant fee for Service (FFS) healthcare payment method in many developing economies and its associated catastrophic health outcomes, the study presents geospatial maps of this urban city and the socio-economic issues it produces. To deliver a successful capitation payment model for healthcare providers in Lagos, Nigeria, the author incorporated a framework model that included incentives and sanctions through an indirect principal-agent relationship, where the principal (enrollees) holds the government accountable for the healthcare provider’s actions (Baez-Camargo & Jacobs 2013). The study in this book concludes by delivering a visual template for transitioning from FFS based healthcare payment system to a more productive environment for both healthcare providers and patients to deliver and receive quality health outcomes and reach the lower-income population.
About the Author
Dr. E. Charles Ezuma-Ngwu is an award-winning top-performing Financial and Budget Analysis and Strategic Performance leader with a proven 20+year track record of dramatically increasing the integrity and utility of financial data used in the healthcare business decision process. He obtained his Ph.D. in Healthcare Administration from the Northcentral University, an MBA from the University of Pittsburg, Katz Graduate School of Business, and B.S in Accounting and Economics from the University of Massachusetts, Lowell, MA. He has extensive experience in research, planning, forecasting, and variance analysis to reduce operational risks in the Healthcare Industry. Dr. Ezuma-Ngwu is happily married and blessed with four children.