The Impact of e-Payment on: Health

1. The Impact of e-Payment on: Health

2. The Government had a Plan Global Health Observatory/CIA world fact book

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 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

4. So how does e-Payments come in Payment convenience for patients? The obvious.

5. 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

6. Data Gathering Capability – POS can help

7. Treatment Information Basic Medical data as a Value Added Service • Patient Information • Financial Information

8. 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

9. Telecoms coverage, the limiting factor Courtesy Bill and Melinda Gates Foundation

10. 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.

11. Two main problem areas • Data Collection and Accuracy • Patient enrollment • Patient Identification • Treatment data • Payments • Hospitals are paid on time for verified services

12. Enrollment Patient goes online to register on NHIS either through NHIS portal directly or through HMO Patient selects an HMO and preferred hospital Records are updated at NHIS for patient HMO then updates records and informs Hospital of new registered patient NHIS PATIENT HMO • 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? HOSPITAL

13. Modified Enrollment Patient goes online to register on NHIS either through NHIS portal directly or through HMO All Hospitals are required to have at least email access for registration as a provider Centralized Registration System allows online access by HMO and Hospitals, and sends periodic patient lists by email Each HMO will develop a patient management system that would provide data to NHIS for statistical purposes NHIS Centralised Patient registration system* HMO PATIENT • Hospitals can send sms to the centralised registry for basic patient verification i.e gender, age, etc. Electronic Patient management system HOSPITAL *Ability to uniquely identify patient (Biometric or otherwise) become important

14. Payment 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

15. Modified Payment NHIS HMO ADMIN FEES NHIS pays Admin fees to the HMO and Capitation to the hospitals directly The Centralized Patient registration System provides data for these payments Centralised Patient registration system CAPITATION HOSPITAL

16. 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.

17. 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 17