ABSTRACT
A web-based information management system for national health insurance scheme(NHIS) will assist the body to have an online registration of people, health maintence organizations (HMOs), accredited heath care providers, etc. Looking  at  the  Nigerian  population,  access  to  health insurance is denied  to a certain category of  people as a result of not being a government worker or not privileged to be duly informed on the operation of the scheme and how to enroll Knowing that Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of token contribution at regular intervals. The scheme (NHIS) is established under the Act 35 of 1999 by the federal Government of Nigeria to improve the health of all Nigerians at affordable cost. The Act also establishes the general rules and guidelines for the operation of the scheme. The methodology used in designing this system is called web engineering process model and will be implemented using PHP-MySql. The significance of this system to NHIS is for availability of the customer data, HMOs and their proper management through an online application.
CHAPTER ONE INTRODUCTION
1.1 Background of the Study
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. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as “coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment” (Gary Caxton, 2008).
The National Health Insurance Scheme (NHIS) of Nigeria was established through Act 35 of 1999 to provide health insurance for
all Nigerians. The National Health Insurance Scheme – Millennium Development Goals/Maternal and Child Health (NHIS – MDGs/MCH) Project addresses Nigeria’s critical problem of poor access to health care services for pregnant women and children under the age of 5 (NHIS, 2014).
Phase 1 covered six Nigerian states (Sokoto, Niger, Gombe, Oyo, Imo and Bayelsa); Phase 2 covered a further six states (Katsina, Jigawa, Yobe, Bauchi, Ondo, and Cross River). So far in Phases 1 and 2 of the project, a total number of 1,545,646 pregnant women and children were covered as at March 2011. Of this figure
1,193,893 are still accessing care while 351,753 have exited the
Project i.e. delivered or are above 5 years of age (NHIS, 2014).
Public or Government health facilities were used due to their availability in rural areas and to ensure health funding at that level. The health service package covers primary and secondary care for pregnant women and only primary care for children; payment to health providers is by Capitation and Fee for Service through Health Management Organizations (HMOs). The source of funding for the
Project is the Debt Relief Gains (DRGs) through the MDG funds and
Federal Government of Nigeria (FGN) appropriations (NHIS, 2014). The objectives of the Nigerian NHIS are mainly
1. To ensure that every Nigerian has access to good healthcare services.
2. To solve the problem of inappropriate use of levels of healthcare, leading to unnecessary cost and under-utilization of specialized facilities ensuring equitable patronage of all levels of health care.
3. To improve and harness private sector participation in health care service delivery and to ensure institutional quality assurance.
4. Protect families from the financial hardship of huge medical bills
5. To ensure equitable distribution of healthcare cost among different income groups
6. Limiting the rise in the cost of healthcare service
7. To maintain high standard of healthcare delivery services within the scheme.
8. To ensure availability of funds to the health sector for improved services and foster research in the health sector.
9. To ensure efficiency in healthcare services
10.To ensure adequate distribution of health facilities within the federation( D. Adesina, 2009)
However, the national health insurance scheme is yet to effectively actualize the above objectives and is currently facing a lot of challenges (R. Abati, 2010)
This study is geared towards developing an online portal for the scheme to register members and have a well-structured data storage system, which makes it flexible for maintenance and management.
1.2 Statement of Problem
Most of the Nigerian health insurance is presently using manual system in their data processing; this involves the use of people, pens and papers in records keeping. This method of data processing reveals a number of problems which includes:
Records to be kept in health insurance system are often too large, diversified and complex to be processed manually.
The record maintenance and operations required on a day-to- day basis are extensive.
Varieties of services carried out in different departments necessitate considerable efforts to ensure that all transactions are taken into proper account.
A lot of files are kept in the office that locating a particular record at times takes a whole lot of time.
People have to visit the health insurance offices before they can get useful information.
Information can be lost when records are stolen, misplaced or vandalized
1.3 Objectives of the Study
The objective of this project is to develop a web based information Management system for National Health Insurance Scheme. The new system will be able to do the following:
(i) Provide Online Registration Processing for the enrolees.
(ii) Do an on-Line accreditation of Health Maintenance
Organizations (HMOs)
(iii) Also do an on-Line Publication of HMOs List
(iv) Provide an on – Line listing of Health care providers.
(v) Provide an on-Line access to change of health service providers to another
(vi) Build a database of all the HMOs and Health providers
(vii) Build a database for the ministries that are registered for the scheme
(viii) Maintain a database security for the National Health
Insurance Scheme (NHIS)
1.4 Significance of the Study
The following are the benefits of developing a web based Management Information System for the National Health Insurance Scheme:
Companies are able to highlight their strengths and weaknesses due to the presence of revenue reports, employees’ performance record etc. The identification of these aspects can help the company improve their business processes and operations.
Giving an overall picture of the company and acting as a communication and planning tool.
The availability of the customer data and feedback can help the company to align their business processes according to the needs of the customers. The effective management of customer data can help the company to perform direct marketing and promotion activities.
1.6 Scope of the Study
The scope of this study stops with re-engineering information system with respect to registrations and health care management in National Health Insurance Scheme through an online application.
1.6 Limitations of Study
This research work is limited on administering the insurance scheme which takes proper records of people enrolled in the scheme, their health providers and the HMOs. Funding of the scheme and financial accounting in the system is not covered in this research.
This material content is developed to serve as a GUIDE for students to conduct academic research
A WEB- BASED MANAGEMENT INFORMATION SYSTEM FOR NATIONAL HEALTH INSUREANCE SCHEME
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