Exploring the Prevalence and Predictors of Persistently High Primary Care Use Among National Health Insurance Patients in a Nigerian Medical Facility

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.