EVALUATION OF DATA FOR QUALITY OF HEALTH

CARE, COST AND ITS UTILIZATION IN MONITORY OF

PATIENTS OUTCOME

1.0. INTRODUCTION
The World Health Organization healthcare industry is in trouble
(Weisbart, 2015). According to the Institute of Medicine of the
National Academy of Science (2012), the United States and some
Africa countries “Nigeria “are the only industrialized nation that does
not have a universal healthcare system. Adults in the Nigerian are
more likely to forgo care because of cost even when they carry
health insurance (Ansar, Johansson, Vásquez, Schulze, & Vaughn,
2017; Henrikson, hang, Ulrich, King, & Anderson, 2017; Zachary et
al., 2016).
Healthcare quality satisfaction remains very low even for people who
have access to health services (Ansar et al., 2017; Zachary et al.,
2016). Further, healthcare quality often affects safety because
if quality goes down, safety will go down as well (Kennedy,
Nordrum, Edwards, Caselli, & Berry, 2015). The lack of care
coordination, efficiency, and patient-centeredness that influences
quality issues may frighten patients, compounding their reluctance to
seek healthcare services (Thomas, Zachary, Helen, & Barbara, 2016).
Patients with one or more chronic and mostly preventable diseases
spend more than 75% of all healthcare due to the rate of getting it
( Maddox, Beaulieu, Wild, & Jha, 2017).
The pricing of healthcare products and services in the Nigeria. is
notoriously complex and expensive and In the healthcare industry,
supply costs are very different from market prices (Danzon, Mulcahy,
& Towse, 2015).In designing the benefit, the insurance provider
decides what prices patients pay out-of-pocket for drugs and other
product.
Governments cannot afford to provide unlimited benefits for its
citizens by shifting the costs to future taxpayers (Sandelowski, 2015;
Sisko et al., 2014). Very few individuals can afford to pay for their
healthcare in case of a significant injury or illness (Guemmegne,
Kengwoung-Keumo, Tabatabai, & Singh, 2014). Healthcare
insurance providers continuously seek to control their risk by
excluding high-risk patients and restricting covered benefits
(Guemmegne et al., 2014).
The U.S. Congressional Budget Office (CBO) and several researchers
have rojected that healthcare’s share of the GDP will double from
15.2% in 2007 to 31% by 2035, will continue to grow steadily to 37%
by 2050, and will reach 46% of the total economy by 2080 (Hatfield,
Favreault, McGuire, & Chernew, 2016; Keehan et al., 2015; Sisko et
al., 2014).

1.1 BACKGROUND OF THE STUD

Health care service delivery in Nigeria falls short of international
standards resulting from poor state of health care infrastructure,
shortage of medical professionals, threat of re-emerging infectious
diseases, and poor sanitation. Over the last five decades post-
independence, growth, and development in health care has been very
poor. HIV/AIDS has regrettably been a very serious health challenge
overtime. About 3.6 million of the populations are HIV positive.
More than 300.000 individuals die from AIDS every year (Arikpo,
Etor, & Usang, 2007). Another major problem is that of infant
mortality. The World Health Organization Report (2008) indicated an
infant mortality of 110 per 1000 live births in Nigeria. As a
comparison, the infant mortality in Sweden is 2.7 per 1000 live births.
Poverty has compounded these problems to give low life-expectancy
of 52 years for women and 49 years for men. Recognizable
demographic differences exist in Nigeria with consequent disparity in
availability of health care facilities across the country (Okeke, 2008;
Ouma & Herselman, 2008). Adequate evalution of clinical data
of patients like the electronic medical record systems help to improve
access to health care in remote suburban areas and ensure improved
maintenance of long-term care (Keenan, Nguyen, & Srinivasan,
2006). Onwujekwe (2005) and Ofovwe and Ofili (2005), in separate
studies conducted to assess patient and community satisfaction, found
discontent with community members who decried the poorly staffed
and inadequately equipped Primary Health Centers (PHCs) in their
rural settlements compared to hospitals in urban centers. Such
demographic disparity in health care accessibility benefits from
hospital information technologies and telemedicine to foster
collaboration between clinicians in urban areas and those in rural
settlements (Ouma & Herselman, 2008). Clinical data evaluation
for patients includes strategic decision support systems and clinical
documentation systems. Some of the clinical support systems include
Laboratory Information Systems (LIS), Radiology Information
Systems (RIS), and Computerized Order Entry (COE).
Others are pharmacy information systems and personal data analysis
systems with important added feature for messaging between
providers and staff, and the ability to share data with other medical
facilities (Keenan et al., 2006). Telemedicine is a unique application
of hospital information technologies. In its simplest form,
telemedicine uses audio-visual information and communications
apparatus to deliver health care services in a bid to modify socio-
economic circumstances of the beneficiaries and improve accessibility
to medical care (Yun & Chun, 2008).
A paucity of government policy regarding the implementation of
clinical data evaluation for patients exists in Nigeria. The lack of
strategic government programs has culminated in the poor adoption of
hospital information technologies in health care facilities across the
country. Okeke (2008) posited that the lack of access to modern
medical health care facilities has compelled many Nigerian patients to
seek treatment with traditional healers and patent medicine dealers.
The more affluent echelon of the society resorts to medical tourism
overseas to obtain health care services, resulting in a loss of foreign
exchange to Nigeria.
According to Okafor-Dike (2008), poor leadership in Nigeria has led
to years of economic downturn affecting every aspect of social life.
Rather than develop medical services in Nigeria, government officials
and wealthy individuals frequently seek medical treatment abroad
even for the most basic health care needs.

1.2 STATEMENT OF THE PROBLE

According to Omeruan et al. (2009), the major challenges of Nigeria
healthcare system have been largely due to the lack of adequate
clinical data of patients. Health services in Nigeria have suffered from
decades of neglect, endangering Nigeria health status and national
productivity. The healthcare system management is in three tiers;
tertiary healthcare- provided by the Federal Government of Nigeria
(FGN), mostly coordinated through the university teaching hospitals
and federal medical centres.
The secondary healthcare provision is by the state governments which
manage the General Hospitals. The third tier is the Local Government
(774 LGAs) which focuses on primary healthcare services
administered in the dispensaries. It is the patients in primary
healthcare services that suffer the most neglect and this has resulted to
poor monitoring of patients which in extreme cases has led to death.
Women, children, and especially the core poor die from avoidable
health issues as a result of patients clinical data neglect.

Nigerian patients are being denied quality clinical data quality

especially those in the rural areas as a result high profile individuals,
especially the political class, continue to fly abroad on regular basis
for medical treatment, further widening the inequality in accessing
healthcare services which has further deteriorated our health care
services leading to avoidable deaths of patients in Nigeria.

In comparison to the European healthcare system, the Nigeria

healthcare system has lower quality care, higher costs, and covers a
smaller percentage of the population (Thomas et al., 2016). Despite
the high costs, the healthcare system remains dysfunctional (Frazier,
2016; La Rocca & Hoholm, 2017). The United States spends
annually approximately $9,523 per person on healthcare, which is
more than 2.5 times the average paid by the other Organization for
Economic Cooperation and Development while some third rated
country are yet to sensuous for accurate figure.
The general business problem is that the high cost of limited and
modest healthcare services jeopardizes the standard of living and the
economic security of citizens. The specific business problem is that
some healthcare managers have limited strategies to improve
efficiency while reducing healthcare costs.

1.3 Nature of the Study

Qualitative researchers explore and analyse the meanings individuals
assign to their experiences and realities. Scholars have argued that
qualitative research is of particular value in management scholarship
because of the focus on describing and
explaining the human interactions, meanings, and processes that
constitute organizational environments (Ary, Jacobs, & Razavieh,
2018; Haslam, Cornelissen, & Werner, 2017; Olasina, 2016).

1.4 AIMS AND OBJECTIVES OF THE STUDY:

1.4i AIMS OF THE STUDY
The major aim of the study is to evaluate clinical data for quality
health care cost and utilization in monitoring patients in Nigeria.
1.4ii OBJECTIVES OF THE STUDY
Specific objectives of the study include;
1. To examine the need for an effective health care delivery in
Nigeria.
2. To determine the importance of health care cost on in Nigeria.
3. To assess the current state of Nigerian health care system in
Nigeria.
4. To examine the challenges to effective evaluation of clinical
data of patients in the Nigeria health care system.
5. To determine the relationship between evaluation of clinical
data of patients and quality health care cost in Nigeria.
6. To recommend ways of improving the evaluation of clinical
data of patients so as to enhance quality health care and
monitory of patients in Nigeria.

1.5 i RESEARCH QUESTIONS:

i. What is the need for an effective health care delivery in Nigeria?
ii. What is the importance of health care cost on in Nigeria?
iii. What is the current state of Nigerian health care system in
Nigeria?
iv. What are the challenges to effective evaluation of clinical data
of patients in the Nigeria health care system?
v. What is the relationship between evaluation of clinical data of
patients and quality health care cost in Nigeria?
vi. What are the ways of improving the evaluation of clinical data
of patients so as to enhance quality health care and monitory of
patients in Nigeria?

1.5ii RESEARCH HYPOTHESES:

 a) There is significant effect of adequate evaluation of
clinical data of patient on quality of health care cost in
Nigeria.
b) There is significant effect of adequate evaluation of
clinical data of patient on quality of health care cost in
Nigeria.
c) There is no significant relationship between evaluation of
clinical data of patient and quality of health care cost in
Nigeria.
d) There is significant relationship between evaluation of
clinical data of patient and quality of health care cost in
Nigeria.

1.6 SIGNIFICANCE OF THE STUDY

The study would be of importance to the development of the health
sector and by extension the development of the economy. The study
would also be of immense importance to students, researchers and
scholars who are interested in developing further studies on the
subject matter by providing relevant literatures for the study.

1.7 SCOPE AND LIMITATION OF THE STUDY

1.7i SCOPE OF THE STUDY :
The study is restricted to the evaluation of clinical data for quality of
health care cost and its utilization in monitoring of patient. using the
Lagos university teaching hospital(LUTH).
1.7ii LIMITATION OF THE STUDY:
Financial constraint</strong>- Insufficient fund tends to impede the
efficiency of the researcher in sourcing for the relevant materials,
literature or information and in the process of data collection (internet,
questionnaire and interview).
1.8 TIME CONSTRAINT
The researcher will simultaneously engage in this study with other
academic work. This consequently will cut down on the time devoted
for the research work.

1.9 CONCEPTUAL FRAMEWORK

I use complex adaptive systems (CAS) theory as the conceptual

framework in the study. CAS theory was one of the scientific study of
complexity (Chiva, Ghauri, & Alegre, 2014; Rogers, Medina, Rivera,
& Wiley, 2005). As organizations open themselves to a multitude of
stimuli, change processes will become more complex.
According to Ellis, Churruca, and Braithwaite (2017), CAS is a
collection of individual variables whose actions are interconnected
(relationships), so that one agent’s actions changes the context for
other agents’ actions (self-organization) compelling them to act in
ways that are not always totally predictable (nonlinear).
The study of complex systems has emerged in the last few decades
from the disciplines of mathematics and physics in three phases
involving relationships, self organization, and nonlinear predictability
(Bountis, Johnson, Provata, & Tsironis, 2016; Radde & Hütt, 2016;
Sivakumar, Puente, & Maskey, 2018). CAS theory is a multi
disciplinary approach to understanding the behaviors of diverse,
interrelated agents and processes from a system-wide standpoint
(Peters, 2014). CAS encompass many components and can self-
organize and adapt. The interactions of system components are
characteristically complex and non-linear and are not easily
controllable or predictable in
details.