EXAMINING THE PREVALENCE AND DETERMINANTS OF PERSISTENTLY HIGH PRIMARY CARE USE AMONG NATIONAL HEALTH INSURANCE ENROLLEES OF A HEALTHCARE FACILITY IN KANO, NORTHWEST NIGERIA.

Background: Among frequent healthcare users is a small group called "high-care users", with ≥ 10 hospital visits annually. They consume a disproportionate share of the healthcare budget, and their care is often inappropriate and unnecessary.

Objectives: To assess the prevalence and determinants of persistent high-care (PHC) use (≥ 10 visits in two consecutive years) among National Health Insurance Authority (NHIA) enrollees.

Methods: This cross-sectional study analyzed the data of 380 randomly selected patients attending the NHIS Clinic of Aminu Kano Teaching Hospital between January and June 2022. Using a data sheet, we collected their 2018 and 2019 data on biodata, clinic visit characteristics, diagnoses, and cost of care (medicines and investigations) from their medical records.

Results: There were more females (62.6%); their mean age was 37.5±16.0years. Three-quarters (285/380) of patients visited the clinic with an infectious disease in 2018/2019, while 37.6%(143/380) visited with a cardiovascular disease (CVD). Only 2.6%(10/380) were PHC users in the two years. The median cost of care for PHC users in 2018 was 30,549.0((IQR), 23,454 - 35,280) naira compared to the 10,290.0(5,856-18,079) naira consumed by non-PHC users. The median cost of care in 2019 was 41,238.5(25522-54020) naira (PHC users) versus 9,523.5(4709-19070) naira (nonPHC users). Older age, tribe and having CVD were significantly associated with PHC use; however, having CVD (OR=11.38, 95%CI [1.15 - 112.26], P=0.037) predicted PHC use.

Conclusion: The prevalence of PHC users was low. However, they consumed 3 to 4 times more resources than the other enrollees. More robust studies will be required to ascertain the complete picture in order to provide appropriate interventions needed to reduce inappropriate/unnecessary visits and cost of care.