Exploring the Prevalence and Predictors of Persistently High Primary Care Use Among National Health Insurance Patients in a Nigerian Medical Facility
Year: 2025
Type: article
Study design: Observational Study
Abstract: RATIONALE: A small group of healthcare users make frequent hospital visits (≥ 10 annually) and consume a disproportionate amount of healthcare resources. Their characteristics among insured patients in developing countries like Nigeria are poorly understood. OBJECTIVES: To assess the prevalence and predictors of persistently high primary care (PHPC) use (≥ 10 visits in two consecutive years) among National Health Insurance Authority (NHIA) enrollees. METHODS: This retrospective cross-sectional study analyzed data from 380 randomly selected patients at the NHIA Clinic of a Nigerian tertiary hospital in 2022. Using a standardized proforma, their 2018 and 2019 data were collected, including biodata, clinic visit characteristics, diagnoses, and costs of medicines and investigations. RESULTS: The sample population was predominantly females (62.6%) with a mean age of 37.5 years. In 2018/2019, 75% (285/380) of patients visited for infectious diseases and 37.6% (143/380) for cardiovascular diseases (CVD). Only 2.6% (10/380) were PHPC users. The median cost of care was higher among PHPC users than the remaining users in 2018 (₦30,549.00 [US$84.60] vs. ₦10,290.00 [US$28.50]; Mann Whitney test [MWT] = 16.73, p < 0.001) and in 2019 (₦41,238.50[US$114.20] vs. ₦9,523.50 [US$26.40]; MWT = 18.81, p < 0.001). Older age, tribe, and having CVD were significantly associated with PHPC use, with CVD being a strong predictor (OR = 11.38, p = 0.037). CONCLUSION: The prevalence of PHPC users was low, yet they consumed 3 to 4 times more resources in medicines and investigations than the other remaining patients. Patients with CVDs could form targets for interventions to reduce unnecessary visits and lower cost of care.
DOI: 10.1111/jep.70081
Institution: Aminu Kano Teaching Hospital
Language: English
Subfield: Finance
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W4409205144