Does National Health Insurance Promote Access to Quality Health Care? Evidence from Nigeria

Ibiwoye, Ade; Adeleke, Ismaila

doi:10.1057/gpp.2008.6

Cited by 38 publications

(51 citation statements)

References 11 publications

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“…One large-scale study of formal sector employees in Lagos [9] found that only11% saw cost as a barrier to membership, but 36% had not heard of the NHIS even though membership among them rose from 4.5% in 2000 to 31.6% in 2006. Gender, age, income, marital status, family size, education and occupation were significant explanatory variables regarding access to health care through NHIS participation.…”

Section: Resultsmentioning

confidence: 99%

“…Concern was raised about the service provided by HMOs and providers by a sample of employees in the formal sector [9]. A study by Onwujekwe and Onoka [37] also revealed that rural dwellers and poorer socio-economic groups mostly accessed low-level and informal providers.…”

Section: Resultsmentioning

confidence: 99%

“…The aim of this study is to compare health and economic indicators, describe the structure of each country’s NHIS within the wider healthcare system, and analyse impacts on equity in financing and access to health care. Ghana was selected as a comparator country for Nigeria as evidence suggests that differences may exist in the level of achievement between these two countries [9]. It is anticipated that the results will provide insights to the benefit of both countries and more widely in developing countries.…”

Section: Introductionmentioning

confidence: 99%

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Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

Odeyemi

Nixon

2013

Int J Equity Health

129

139

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BackgroundNigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country’s NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care.MethodsThe World Bank and other sources were used to provide comparative health and economic data. Pubmed, Embase and EconLit were searched to locate studies providing descriptions of each NHIS and empirical evidence regarding equity in financing and access to health care. A diagrammatical representation of revenue-raising, pooling, purchasing and provision was produced in order to analyse the two countries’ systems.ResultsOver the period 2000–2010, Ghana maintained a marked advantage in life expectancy, infant mortality, under-5 year mortality, and has a lower burden of major diseases. Health care expenditure is about 5% of GDP in both countries but public expenditure in 2010 was 38% of total expenditure in Nigeria and 60% in Ghana. Financing and access are less equitable in Nigeria as, inter alia, private out-of-pocket expenditure has fallen from 80% to 66% of total spending in Ghana since the introduction of its NHIS but has remained at over 90% in Nigeria; NHIS membership in Nigeria and Ghana is approximately 3.5% and 65%, respectively; Nigeria offers a variable benefits package depending on membership category while Ghana has uniform benefits across all beneficiaries. Both countries exhibit improvements in equity but there is a pro-rich and pro-urban bias in membership.ConclusionsMajor health indicators are more favourable in Ghana and overall equity in financing and access are weaker in Nigeria. Nigeria is taking steps to expand NHIS membership and has potential to expand its public spending to achieve greater equity. However, heavy burdens of poverty, disease and remote settings make this a substantial challenge. Ghana’s relative success has to be tempered by the high number of exemptions through taxation and the threat of moral hazard. The results and methods are anticipated to be informative for policy makers and researchers in both countries and other developing countries more widely.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

Odeyemi

Nixon

2013

Int J Equity Health

129

139

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“…[39] Other factors such as poor medical facilities, shortage of medical personal, lack of awareness, and poor funding have been identified as challenges that affect the efficacy of NHIS in Nigeria. [40][41][42][43] Various stakeholders have also raised issues about the potential mismanagement and bureaucracy that may affect the scheme. [37] …”

Section: Out-of-pocket Paymentsmentioning

confidence: 99%

Public health care financing in Nigeria: Which way forward?

Olakunde¹

2012

Ann Nigerian Med

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“…This was supported by a study in Nigeria which found that married couples have a higher tendency to subscribe to the National Health Insurance (NHI) than persons who were not married [22]. Formerly married members of the community as well as those who have never been married were seen as less likely to participate in a public health insurance programme [23].…”

Section: Discussionmentioning

confidence: 99%

A quantitative study on factors influencing enrolment of dairy farmers in a community health insurance scheme

Greef

Monareng

Roos

2016

BMC Health Serv Res

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BackgroundAccess to affordable and effective health care is a challenge in low- and middle- income countries. Out-of-pocket expenditure for health care is a major cause of impoverishment. One way to facilitate access and overcome catastrophic expenditure is through a health insurance mechanism, whereby risks are shared and financial inputs pooled by way of contributions. This study examined factors that influenced the enrolment status of dairy farmers in Western Kenya to a community health insurance (CHI) scheme.MethodsQuantitative, cross-sectional research was used to describe factors influencing the enrolment in the CHI scheme. Quota and convenience sampling was used, recruiting a sample of 135 farmers who supply milk to a dairy cooperation. Data were collected using a structured interview schedule and analysed using Stata SE, Data Analysis and Statistical Software, Version 12.ResultsFactors influencing non-enrolment were identified as affordability (40%; n = 47), unfamiliarity with the management of the scheme (37%; n = 44) and a lack of understanding about the scheme (41%; n = 48). An exploratory factor analysis was used to reduce the variables to two factors: information provision and understanding community health insurance (CHI). Logistic regression identified factors associated with enrolment in the Tanykina Community Healthcare Plan (TCHP). Supplies of less than six litres of milk per day (OR: 0.22; 95% CI: 0.06–0.84) and information provision (OR: 8.77; 95% CI: 2.25–34.16) were significantly associated with enrolment in the TCHP.Nearly 30% (29.6%; n = 40) of the respondents remarked that TCHP is expensive and 17% (n = 23) asked for more education on CHI and TCHP in an open-ended question.ConclusionRecommendations related to marketing strategies, financial approach, information provision and further research were outlined to be made to the management of the TCHP as well as to those involved in public health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1925-1) contains supplementary material, which is available to authorized users.

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Does National Health Insurance Promote Access to Quality Health Care? Evidence from Nigeria

Cited by 38 publications

References 11 publications

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

Public health care financing in Nigeria: Which way forward?

A quantitative study on factors influencing enrolment of dairy farmers in a community health insurance scheme

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