National health insurance scheme: how protected are households in Oyo State, Nigeria from catastrophic health expenditure?

Abstract

Background: The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods: The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results: The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000-680,000 naira (46.7-4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1-118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile (P= 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3-16.8), P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion: Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE.

A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

“…Elements of the criteria that did not apply to a particular study were marked as not applicable. All the studies fulfilled most of the quality criteria except for five studies that did not provide a sample size justification and power description . Also, 13 of the studies did not measure key potential confounding variables measured nor adjust for them statistically …”

“…All the studies fulfilled most of the quality criteria except for five studies that did not provide a sample size justification and power description. 20,21,[29][30][31] Also, 13 of the studies did not measure key potential confounding variables measured nor adjust for them statistically. 6,20,23,24,[30][31][32][33][34][35][36][37][38]…”

“…The incidence of CHE in different health conditions ranged from 6.6% to 63.6%. 6,20,22,23,29,37 This was highest for inpatient treatment of childhood epilepsy at 63.6% 37 while tuberculosis had the highest incidence of outpatient CHE at 44% 22 (Table 2).…”

Perceptions of focused prenatal care among women attending two tertiary centers in Nigeria

“…This preference could be due to various factors: the prohibitive cost of cesarean delivery; the need for the patient both to avoid losing time at work for postoperative recuperation and to continue to support themselves, their newborn, and their families; or concerns regarding post‐cesarean defeminization [24]. These factors are especially relevant in Nigeria, where only approximately 5% of the population is covered by Nigeria National Health Insurance Scheme [25].…”

Catastrophic Expense & Financial Protection Mechanisms to Achieve Universal Health Coverage: A Review

“…Illiteracy is additional contributor. 2,3,5,6,9,11,12,14,15 Patients had to take loans and dispose assets to meet the catastrophic expenses. [16][17][18] Studies indicate that expenses on indoor hospitalizations are catastrophic especially for poor.…”