**5. Results**

**Table 1** shows the results obtained from the respondents to the question: "Does capitation increase the revenue of your healthcare facility?"

**Table 1** presents data on whether the capitation payment to the healthcare facilities by the NHIS had increased the revenue of the facilities or not. Majority of the respondents 88.63% said the capitation paid by the NHIS through the Health Maintenance Organization (HMOs) had increased the revenue of the providers.

The view of the majority of the respondents who took part in this study was equally the view of the NHIS Coordinator Yobe State AlhajiDabo I. Abdullahi one of the key informants. He claimed that:

*One of the objectives of the Scheme is to ensure the availability of funds to the healthcare sector for improved services. Without a doubt, the NHIS capitation payment to the healthcare providers has served as a fundamental way of generating the healthcare facilities' revenue. NHIS has been paying a lot of money for both public and private health care facilities [17].*

*(KII with AlhajiDabo I. YobeState, NHIS Coordinator on, 4th November 2021)*

**Table 2** shows the results obtained from the respondents to the question: "Do you efficiently utilize capitation resources in your healthcare facility?"

**Table 2** sheds an insight on the effects of the utilization of the resources paid to healthcare facilities as a capitation by the Scheme. **Table 2** shows that the majority of the respondents 80.63% have agreed that the capitation paid to facilities have been used for the supply of drugs and other consumables.

More so, for the maintenance of the healthcare facilities, **Table 2** also shows that 56.81% of the respondents confirmed that the capitation has been utilized for the provision of infrastructure and other hospital equipment. Additionally, it shows that


#### **Table 1.**

*Effect of capitation in healthcare facilities revenue.*

65.90% of the respondents proved that part of the capitation resources had been used for daily maintenance of the facilities.

In regards to the staff welfare, **Table 2** also shows that about 70.45% of the respondents have agreed that part of the capitation payment had been used for the improvement of the workers' welfare in the facilities.

The effect of capitation payment to the healthcare facilities in Yobe State is not only confirmed by the respondents in the table twos above but also the evidence below from the interview with the Yobe State Coordinator. The Coordinator Alh. Dabo I. Abdullahi commented like this:

*The impacts of NHIS capitation payment to the healthcare facilities through Health Maintenance Organizations (HMOs) are tremendous. In my experience as Coordinator in the state, I came across many facilities that had judiciously utilized their capitation resources for purchasing qualitative drugs as well as facilitating infrastructural development in their facilities. However, in some facilities with a high number of enrollees, part of their capitation also had been utilized for the welfare of their staff [17].(KII with Alh. Dabo I. Abdullahi NHIS, Yobe State Coordinator, on the 4th November, 2021)*


#### **Table 2.**

*Effect on efficient utilization of capitation resources by healthcare facilities.*

*An Assessment of the Effect National Health Insurance Scheme Capitation Payment… DOI: http://dx.doi.org/10.5772/intechopen.102545*

**Table 3** shows the results obtained from respondents to the question: "Do you think competition to have more enrollees increase among the healthcare facilities?".

**Table 3** sheds light on how capitation payments by the NHIS to the healthcare facilities increase competition among the facilities in the state. About 79.54% of the respondents confirmed that capitation payment had increased competition to have more enrollees among the healthcare providers in Yobe State. This table indicates that, only 11.36% of the respondents said capitation did not increase competition.

The data were obtained from the key informant interview with Alh. Mansur Akilu, Head of Human Resources and Administration NHIS Yobe State reinforced the position of 79.54% of respondents in **Table 3**. The position is captured below:

*I observed that the capitation system increased competition to acquire more enrollees. The private healthcare facilities are competing to provide quality services to their NHIS patients in order to have more people and to retain their existing customers. Undoubtedly, facilities with more enrollees get more money from capitation payments [18].*

*(KII with Alh. Mansur Akilu, NHIS Head Human Resources and Admin Yobe State on 5th November 2021)*

Additionally, AdamuShuwa an Accountant in the Yobe State NHIS Office concur the above view where his opinion is expressed below:

*Capitation payment had increased competition by the hospital to provide qualitative service with the view to have more customers. In Yobe State, sometimes the healthcare facilities stop collecting 10% co-payment on drugs in order to retain their enrollees and not change to other providers [19].*

*(KII with AdamuShuwa, Accountant, NHIS Yobe State on the 5th November 2021).*

**Table 4** shows the results obtained from the respondents to the question: "Do you satisfy with the services given to you by your chosen healthcare facility?"

**Table 4** above presents the data on whether the enrollees are satisfied with the Scheme service or not. The table indicates that the majority of the respondents, about 72.23%, were satisfied with the Scheme services that have been given to them in their respective healthcare facilities. While 22.66% of the respondents that have taken part in this study said that they were not satisfied with the services given to them by the healthcare facilities.


**Table 3.**

*Effect of capitation in the increase of competition among the facilities.*


#### **Table 4.**

*Effect of capitation on the Enrollees' satisfaction.*

One of the key informants Alhaji Abubakar Uthman, the Head of Quality Assurance, supports the view of the majority of respondents, about 72.23% that said they were satisfied with the services given to them. The key informant commented, thus:

*NHIS is very serious about the quality of services given to its enrollees, hence, we are always engaging on the quality assurance visit to the healthcare providers. In Yobe State, knowing it by healthcare facilities, substandard service can lead to the finality on their side so they give services that would satisfy the enrollees [20] (KII with Alh. Abubakar Uthman SQA Yobe State, on 4th November 2021)*

Another view from Alh. Gambo Gwadabe of Enlightenment Division NHIS Yobe State on the enrollee satisfaction:

*Enrollees usually come for a change of providers if they are not satisfied with the services given to them by the healthcare providers. NHIS gives the provision of change in order to make facilities to provide quality services to the customers.*

On top Alh. Gambo also stated the following:

*Enrollees do not need only quality drugs or other services but also the cutesy, good reception, since from the gate of the hospital. Time is also crucial to the enrollees; customers are very happy with the provider that would promptly attend them without wasting much of their time [21]. (KII with Alh. Gambo Gwadabe Head of Enlightenment NHIS, Yobe State on 6th November 2021)*

Finally, another key informant, Dr. Auwal Ibrahim expresses that:

*Regular spot checks by the NHIS can boost the quality of services provided by the healthcare facilities, hence regular visits help NHIS to identify the lapses in healthcare facilities and recommend where to improve for better services to the enrollees [22]. (KII with Dr. Auwal Ibrahim SQA NHIS Yobe State on 6th November 2021)*

**Table 5** presented the data on whether the capitation payment would be sustained to the question and provides the answers "Do you think the capitation payment is sustainable?". Majority of the respondents, 77.27% confirmed that the capitation payment system is sustainable. Only 18.88% of the respondents that have taken part in this study said the system is not a sustainable kind of payment.

*An Assessment of the Effect National Health Insurance Scheme Capitation Payment… DOI: http://dx.doi.org/10.5772/intechopen.102545*


#### **Table 5.**

*Sustainability of the capitation system.*

The qualitative data from the key informant interview referred to just below agrees that the capitation payment system would be sustainable. This view is the opinion of Alh. Sani Zakari of the Formal Sector Social Health Insurance Programme unit who stated, thus:

*Since the flagging off of the formal sector program in 2005 capitation payment has continued to flourish as one of the best payments of the NHIS to healthcare facilities through the HMOs. In my own opinion capitation payment has come to stay. (KII with Sani Zakari Formal Sector, NHIS Yobe State on 4th November 2021)*

The findings of this study may be summarized as follows:


7.Finally, this study also gathers information about some challenges of capitation payment to the healthcare providers as the delay in payment by the HMOs, sharp practices by the HMOs, mismanagement of the fund by the healthcare facilities, default of making payment by the HMOs, and lack of monitoring of the utilization of the fund by the healthcare facilities.

As a result of the findings from key informant interviews, the following challenges of capitation payment to the healthcare facilities in Yobe State were created:

