Keywords: Adjustment, Community-health, Health-insurance, Primary-care, Risk
As in many other developing countries, affordability and accessibility to health care in Nigeria have always been a matter of great concern. The hope of the average Nigerian to have reliable and affordable healthcare delivery system was brightened with the take-off of the National Health Insurance Scheme (NHIS) in 2005. However, Social Health Insurance Schemes like other forms of health insurance have both health and financial risks. One method for securing the required expenditure control is by health risk assessment and health risk adjustment. The lacuna discovered in most of the existing diagnoses-based risk adjustment model literatures is that International Classification of Diseases (ICD) codes were used and none of the existing models is designed specifically for primary healthcare in a community based health insurance (CBHI). This study applied International Classification of Primary Care (ICPC) codes to develop diagnostic-based health risk adjustment model in order to predict future claims among the enrollees of a Community Based Social Health Insurance Programme (CBSHIP). The data used for this study include claim and enrollment information for Community Based Social Healt