The Financial Protection of National Health Insurance: Evidence From a Cross Section of State and Federal Workers in Akwa Ibom, Nigeria 

Abstract

Background: Public health insurance schemes can offer households financial protection against health care costs and help to resolve inequality in health care provision. The current study evaluates the impact of the Nigerian National Health Insurance Scheme (NHIS) in reducing financial hardship for a sample of Nigerian households working in the health and higher education sectors. The data allows us to examine the variation in the financial protection effects across different income groups and explore differences in standard of living by households with coverage and those without.Methods: Data was gathered in Akwa Ibom state, Nigeria. A cluster sampling technique is used to compare participants and non-participants in the NHIS and within this, identify equivalent groups with regard to household characteristics such as education level, income and household composition. A propensity score matching approach examines variations in out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and number of household assets across the insured and uninsured groups controlling for cofounding factors.Results: The likelihood of experiencing CHE for a household that is insured is estimated to be 82% lower than that of an insured household, even after controlling for our variety of observable characteristics. OOPEs are ₦50,000 lower in households with insurance compared to those without. We additionally find a significant difference in standard of living, as measured by household asset ownership across the insured and non-insured groupsConclusions: There is a statistically and practically significant association between participation in the NHIS scheme and household financial protection. This provides support to policy-makers seeking to design and extend equitable health-financing policies.

Do National Health Insurance Schemes Guarantee Financial Risk Protection in the drive towards Universal Health Coverage in West Africa? A Systematic Review of Observational Studies

“…The included studies reported different effects of NHI on CHE at different thresholds of household total income (expenditure) and non-food expenditure. In more than half of the included studies (5 out of 9), NHI was reported to have a positive effect (protective factor) on CHE [39–42, 46]. In addition, one of these five studies reported a positive effect of NHI on impoverishment due to health spending [40].…”

“…This study focused on FSSHIP and as such described its financing mechanism [39]. It reported that the funding for the FSSHIP comes from an annual premium that is 15% of an employee’s annual basic salary which is a shared contribution between the employee (5%) and the employer (10%).…”

“…The HMOs are usually publicly or privately owned limited liability companies who aim at providing cost- effective healthcare delivery. Payment of providers under the FSSHIP depends on whether care received by insured is at primary healthcare facility, secondary or tertiary healthcare facility: for primary care payment is by capitation whereas for secondary and tertiary care, payment for services provided is based on fee-for-service [39].…”

“…The financial risk protection effect of NHI was evidenced in this review when majority of the included studies (6 out of 9) reported a protective effect of NHI on CHE with one study of these additionally reporting a protective effect of NHI on impoverishment due to health spending [39-42, 46, 47]. These results were consistent with a systematic review on the effect of NHI on financial risk protection conducted in 2019 among LMICs which reported a protective effect of NHI on CHE in majority (9 out of 14) of the included studies [51].…”

“…These findings regarding a protective effect of NHI on CHE were observed at different thresholds of CHE which included threshold exceeding: 40% of a household’s non-food expenditure [39, 40, 42], 10% of a household’s non-food expenditure [41, 47] and 10% of a household’s annual income [46]. However, other included studies found non-significant effects of NHI on CHE at thresholds exceeding 10% of income per capita [43], 20% of annual household income [45] and 40% of a household’s non-food expenditure [47].…”