The Impact of e-Payment on: Health

The Government had a Plan

Global Health Observatory/CIA world fact book

StatisticsTotal Population 174,507,539 (July 2013)

Gross National Income per Capital (PPP in US Dollars) 2,800 (2012 est.)

Life expectancy at birth m/f (years) 49.35/55.77

Probability of dying under five (per 1,000 birth) 124

Probability of dying between 15 and 60 years m/f (per 1,000 Population) 393/360

Total expenditure on health per capital (In US Dollars) 139 (2011 est.)

Total expenditure on health as % of GDP (2011) 5.3

The Government had a Plan

Millennium Development Goals (MDG)

• MDG 4: Reduce child mortality.• MDG 5: Improve maternal health.• MDG 6: Combat HIV/AIDS, malaria and other diseases.

The government has also used debt relief for social safety net policy initiatives, such as; Conditional Cash Transfers (CCTs), the Micro-Credit Scheme andthe Small and Medium Enterprises Development Agency of Nigeria (SMEDAN) Vocational Training Scheme.

Other initiatives are the MDGs Costing and Needs Assessment, Universal Basic Education Counterpart Fund Scheme, HIV&AIDS (distribution of antiretroviral drugs), the Community Health Insurance Scheme, the Rollback Malaria Partnership with the Global Fund (providing insecticide-treated mosquito nets to every Nigerian family) and the development of a National Gender Data Bank.

MDG Report 2010

So how does e-Payments come in

Payment convenience for patients? The obvious.

Key Gaps and Challenges

The capacity of Institutions to gather data is very weak and second the data available are not reliable or consistent.

Poor access to health facilities, particularly primary health care; and attendant qualified staffing

High cost of health care. Out-of-pocket spending by households on health care is as high as 64.6 per cent of household budgets

MDG Report 2010

Data Gathering Capability – POS can help

June July August Average Volume

4,800

4,900

5,000

5,100

5,200

5,300

5,400

5,500

5,600

5,700

90,000,000

92,000,000

94,000,000

96,000,000

98,000,000

100,000,000

102,000,000

POS Hospital Data

Volume Value

Transaction Range # of Transactions

1 -5 220

6 -15 105

16 -50 82

51 -100 24

101 -500 29

500 -1000 5

> 1000 1

# of Unique Merchants 466

Average Transaction amount (N) 18,185.92

Basic Medical data as a Value Added Service

Treatment Information

Patient Information

Financial Information

Sent as a Payment

Transaction

Treatment Information

Patient Information

Financial Information

Poor Access to Facilities - Telemedicine

In its early manifestations, African villagers used smoke signals to warn people to stay away from the village in case of serious disease.

Wikipedia

Within the remit of “e” but not e-payments

Telecoms coverage, the limiting factor

Courtesy Bill and Melinda Gates Foundation

Health Insurance

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement.

On October 15th, the National Health Insurance Scheme was launched in Nigeria. The enabling law Decree 35 of 1999 (now Act 35 of 1999) was signed in May 1999.

Two main problem areas

Data Collection and Accuracy• Patient enrollment• Patient Identification• Treatment data

Payments• Hospitals are paid on time for verified services

Enrollment

PATIENT

NHIS

HMO

HOSPITAL

1. Patient goes online to register on NHIS either through NHIS portal directly or through HMO

2. Patient selects an HMO and preferred hospital

3. Records are updated at NHIS for patient

4. HMO then updates records and informs Hospital of new registered patient

QUESTIONS

• How can hospital verify identity of patients on NHIS registered to them?

• How can NHIS guarantee that in the event of an emergency a member of the scheme will get treated at any hospital?

Modified Enrollment

PATIENT

NHIS

HMO

HOSPITAL

1. Patient goes online to register on NHIS either through NHIS portal directly or through HMO

2. All Hospitals are required to have at least email access for registration as a provider

3. Centralized Registration System allows online access by HMO and Hospitals, and sends periodic patient lists by email

4. Each HMO will develop a patient management system that would provide data to NHIS for statistical purposes

• Hospitals can send sms to the centralised registry for basic patient verification i.e gender, age, etc.

Centralised Patient

registration system*

Electronic Patient management system

*Ability to uniquely identify patient (Biometric or otherwise) become important

Payment

NHIS

HMO

HOSPITAL

1. NHIS pays Capitation and Admin fees to the HMO who then forward the Capitation fees to the Hospital

PROBLEM

• HMOs incur additional charges transferring Capitation to the hospitals.

• Some HMOs delay payments of Capitation thereby impairing the working capital of the hospitals

CAPITATION

CAPITATION

ADMIN FEES

Modified Payment

NHIS

HMO

HOSPITAL

1. NHIS pays Admin fees to the HMO and Capitation to the hospitals directly

2. The Centralized Patient registration System provides data for these payments

CAPITATION

ADMIN FEES

Centralised Patient

registration system

Summary

The way forward is to look at Health sector initiatives in e-payment as Value Added Services.

The value is in the medical and patient information that can accompany a financial transaction.

The success will be dependent on the communication network, data to shared and lots of training.

As with most things technology, it is not about the technology but about the people.

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Nigeria Inter-Bank Settlement System Plc… improving the Nigeria Payments System

1230B Ahmadu Bello Way Victoria Island,

Lagos, Nigeria

Tel: +234 1 2716071-4

www.nibss-plc.com