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WITHDRAWN: Modeling Health Maintenance Organizations Payments Under the National Health Insurance Scheme in Nigeria


Keywords: Health care, logistic regression, National Health Insurance Scheme

The Nigerian National Health Insurance Scheme (NHIS) is designed to facilitate fair financing of health care costs through pooling and the judicious use of financial risk protection and cost-burden sharing for people against the high cost of health care. Health Maintenance Organizations (HMO) are limited liability companies that may be formed by private or public establishments or individuals for the sole purpose of participating in the scheme. Their functions include payment of health care providers for all or part of services rendered. This paper explores two predictive models---logistic regression and random forests---to determine the factors that determine whether an HMO will pay all or part of an individual's health care bill. Data are from the Nigerian NHIS of more than 55,000 cases over a two-year period and consisting of age, classification of illness, kind of ailment, medical bill, and HMO payment. It was observed that the bulk of individuals who take advantage of the NHIS fall within the ages of 31-40 and the classification of the ailment and age of the insured are major determinants of whether an HMO will pay all or part of the bill.