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      Role of digital health insurance management systems in scaling health insurance coverage in low- and Middle-Income Countries: A case study from Nigeria

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          Abstract

          Background

          Increasing global commitment to Universal Health Coverage (UHC) in the past decade has triggered UHC-inspired reforms and investments to expand health service coverage in many Low- and Middle-Income Countries (LMICs). UHC aims to ensure that all people can access quality health services, safeguard them from public health risks and impoverishment from out-of-pocket payments for healthcare when household members are sick

          Aim

          This paper reviews the role of health insurance as a policy tool to address health financing as a contributory mechanism for accelerating the achievement of UHC in LMICs. We focus on Nigeria's legal framework for health insurance coverage for its whole population and the role of technology in facilitating enrollment to health insurance schemes.

          Methods

          From May to July 2022, we adopted a cross-sectional case study design combining: (i) a literature review of the effects of UHC with (ii) document analysis of health insurance systems in Nigeria, and (iii) secondary analysis of health insurance datasets to understand experiences of deploying MedStrat, a locally-developed digital health insurance management system, and its features that support the administration of health insurance schemes in multiple states of Nigeria. We drew on contemporary technology adoption models to triangulate diverse data analyzed from literature and documents reviews and from health insurance datasets to identify: (i) enablers of adoption of digital insurance schemes, (ii) the contribution of digital technology to expanding access to health insurance, and (iii) further scalability of digital insurance intervention.

          Results

          Preliminary findings suggests that digital insurance management systems can help to increase the number of enrollees for insurance especially among poor households. Three contextual enablers of adoption of digital insurance schemes were a favourable policy environment, public-private-partnerships, and sustained stakeholder engagement and training.

          Discussion and conclusion

          Key elements for successful scaling of digital health insurance schemes across Nigeria and similar contexts include: (i) ease of use, (ii) existing digital infrastructure to support electronic insurance systems, and (iii) trust manifested via data encryption, maintaining audit trails for all data, and in-built fraud prevention processes. Our findings affirm that digital health technology can play a role in the attainment of UHC in LMICs.

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          Most cited references55

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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Digit Health
                Journal ID (iso-abbrev): Front Digit Health
                Journal ID (publisher-id): Front. Digit. Health
                Title: Frontiers in Digital Health
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2673-253X
                Publication date (Electronic): 20 September 2022
                Publication date Collection: 2022
                Volume: 4
                Electronic Location Identifier: 1008458
                Affiliations
                [ 1 ]Instrat Global Health Solutions , Abuja, Nigeria
                [ 2 ]School of Business, Montclair State University , Montclair, NJ, United States
                [ 3 ]Department of Information / Communications Technology, National Health Insurance Authority , Abuja, Nigeria
                [ 4 ]Adamawa State Contributory Health Management Agency , Yola, Adamawa State, Nigeria
                [ 5 ]Ogun State Contributory Health Insurance Agency , Abeokuta, Ogun State, Nigeria
                [ 6 ]Ondo State Contributory Health Commission , Akure, Ondo State, Nigeria
                [ 7 ]Leeds Institute for Health Sciences, University of Leeds , Leeds, United Kingdom
                Author notes

                Edited by: Mihajlo (Michael) Jakovljevic, Hosei University, Japan

                Reviewed by: Abdullah Tirgil, Ankara Yıldırım Beyazıt University, Turkey Christie Akwaowo, University of Uyo, Nigeria

                [* ] Correspondence: Okey Okuzu okey@ 123456instratghs.com

                Specialty Section: This article was submitted to Health Technology Implementation, a section of the journal Frontiers in Digital Health

                Article
                DOI: 10.3389/fdgth.2022.1008458
                PMC ID: 9530809
                PubMed ID: 36204711
                SO-VID: 970c26a7-44aa-4cf8-b5e2-fc8d99894a3b
                Copyright © © 2022 Okuzu, Malaga, Okereafor, Amos, Dosunmu, Oyeneyin, Adeoye and Ebenso.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 31 July 2022
                Date accepted : 31 August 2022
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 64, Pages: 0, Words: 0
                Categories
                Subject: Digital Health
                Subject: Original Research

                Keywords: scale-up,digital technologies,health insurance,universal health coverage,nigeria
                Data availability:
                Keywords: scale-up, digital technologies, health insurance, universal health coverage, nigeria

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