The Impact of e-Payment on: Health
The Government had a Plan
Statistics
Total 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
Global Health Observatory/CIA world fact book
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 and
the 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
5,700
102
5,600
100
# of Transactions
220
6 -15
105
16 -50
82
51 -100
24
101 -500
29
500 -1000
5
94
> 1000
1
92
# of Unique Merchants
90
Average Transaction
amount (N)
98
5,300
96
5,200
5,100
Transaction Range
1 -5
5,500
5,400
N'Millions
POS Hospital Data
5,000
466
4,900
4,800
June
July
Volume
August
Value
Average
Volume
18,185.92
Basic Medical data as a Value Added Service
Treatment
Information
Treatment
Information
Patient
Information
Financial
Information
Sent as a
Payment
Transaction
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
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
NHIS
PATIENT
HMO
QUESTIONS
HOSPITAL
• 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
NHIS
Centralised
Patient
registration
system*
HMO
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
PATIENT
Electronic
Patient
management
system
HOSPITAL
• Hospitals can send sms to the
centralised registry for basic
patient verification i.e gender,
age, etc.
*Ability to uniquely identify patient (Biometric or
otherwise) become important
Payment
1. NHIS pays Capitation and
Admin fees to the HMO who
then forward the Capitation
fees to the Hospital
NHIS
CAPITATION
HMO
ADMIN
FEES
CAPITATION
PROBLEM
• HMOs incur additional charges
transferring Capitation to the
hospitals.
• Some HMOs delay payments of
Capitation thereby impairing the
working capital of the hospitals
HOSPITAL
Modified Payment
NHIS
HMO
ADMIN
FEES
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
Centralised
Patient
registration
system
CAPITATION
HOSPITAL
Summary
The way forward is to look at Health sector initiatives in epayment 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.
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
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