Social inclusion in health insurance schemes in Rivers State, Nigeria
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Abstract
BACKGROUND: Social health insurance (SHI) is a key tool for achieving universal healthcare by pooling funds to provide financial protection and cross-subsidisation. Many vulnerable groups remain excluded from health insurance coverage, and implementing strategies to expand coverage among these populations is essential for reducing inequities. This study determined and compared the role of public, private, and community-based health insurance schemes in enhancing social inclusion in health care services in Rivers State.
METHODS: A mixed-method study was conducted in Rivers State, gathering data from health insurance enrollees to assess the inclusion of vulnerable individuals within their households in health insurance schemes. The data were analysed using STATA version 14 and NVIVO vs (for quantitative and qualitative data, respectively) with a significance level set at 0.05.
RESULTS: The study found that the presence of pregnant women in households is significantly associated with a 21.19% increase in the likelihood of opting for community-based insurance [p = 0.024, CI = 0.0278-0.3960]. In contrast, other sociodemographic factors, including having children that are under-five, adults above 60 years, physically challenged individuals, and visually impaired individuals, did not demonstrate statistically significant effects on insurance selection across public, private, or community schemes. Notably, premium payment consistently emerged as a significant barrier to selecting both public (OR = 0.11, p < 0.001) and community insurance (OR = 0.10, p < 0.001).
CONCLUSION: A significant portion of the most vulnerable individuals were excluded from health insurance schemes. Therefore, it is essential for these schemes to implement measures that promote social inclusion for vulnerable populations.
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References
Le QN, Blizzard L, Si L, Giang LT, Neil AL. The evolution of social health insurance in Vietnam and its role towards achieving universal health coverage. Health Policy OPEN. 2020 Dec;1:100011.
Adebayo EF, Uthman OA, Wiysonge CS, Stern EA, Lamont KT, Ataguba JE. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries. BMC Health Serv Res. 2015 Jun;15(1):543.
Hussien M, Azage M. Barriers and Facilitators of Community-Based Health Insurance Policy Renewal in Low- and Middle-Income Countries: A Systematic Review. Clin Outcomes Res. 2021 May;Volume 13:359–75.
Derkyi-Kwarteng ANC, Agyepong IA, Enyimayew N, Gilson L. A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa. Int J Health Policy Manag. 2021 Jul 1;10(7):443–61.
Okoroh J, Essoun S, Seddoh A, Harris H, Weissman JS, Dsane-Selby L, et al. Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review. BMC Health Serv Res. 2018 Dec;18(1):426.
Fadlallah R, El-Jardali F, Hemadi N, Morsi RZ, Abou Samra CA, Ahmad A, et al. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review. Int J Equity Health. 2018 Dec;17(1):13.
Mills E, Singh S, Wilson K, Peters E, Onia R, Kanfer I. The challenges of involving traditional healers in HIV/AIDS care. Int J STD AIDS. 2006 Jun 1;17(6):360–3.
Eze P, Ilechukwu S, Lawani LO. Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis. Vojnov L, editor. PLOS ONE. 2023 Jun 27;18(6):e0287600.
Okedo‐Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage. Int J Health Plann Manage [Internet]. 2019 Oct [cited 2024 Oct 5];34(4). Available from: https://onlinelibrary.wiley.com/doi/10.1002/hpm.2847
Ipinnimo TM, Durowade KA, Afolayan CA, Ajayi PO, Akande TM. The Nigeria National Health Insurance Authority Act and its Implications towards Achieving Universal Health Coverage. Niger Postgrad Med J. 2022 Oct;29(4):281–7.
Akinyemi O, Harris B, Kawonga M. Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria. BMC Health Serv Res. 2019 Dec;19(1):938.
Alawode GO, Adewole DA. Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare and insurance providers. BMC Public Health. 2021 Jan 11;21(1):124.
Akwaowo CD, Umoh I, Motilewa O, Akpan B, Umoh E, Frank E, et al. Willingness to Pay for a Contributory Social Health Insurance Scheme: A Survey of Rural Residents in Akwa Ibom State, Nigeria. Front Public Health. 2021 Jun 17;9:654362.
Ezenwaka U, Manzano A, Onyedinma C, Ogbozor P, Agbawodikeizu U, Etiaba E, et al. Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study. Front Public Health. 2021 Jul 6;9:670534.
Aregbeshola BS, Khan SM. Out-of-pocket health-care spending and its determinants among households in Nigeria: a national study. J Public Health. 2021 Aug;29(4):931–42.
Sageer R, Kongnyuy E, Adebimpe WO, Omosehin O, Ogunsola EA, Sanni B. Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria. BMC Pregnancy Childbirth. 2019 Dec;19(1):63.
Odeyemi IA, Nixon J. Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis. Int J Equity Health. 2013;12(1):9.
Vilcu I, Probst L, Dorjsuren B, Mathauer I. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Int J Equity Health. 2016 Dec;15(1):165.
Shobiye HO, Dada I, Ndili N, Zamba E, Feeley F, De Wit TR. Determinants and perception of health insurance participation among healthcare providers in Nigeria: A mixed-methods study. Rajiah K, editor. PLOS ONE. 2021 Aug 4;16(8):e0255206.
Obadha M, Chuma J, Kazungu J, Barasa E. Health care purchasing in Kenya: Experiences of health care providers with capitation and fee‐for‐service provider payment mechanisms. Int J Health Plann Manage [Internet]. 2019 Jan [cited 2024 Sep 24];34(1). Available from: https://onlinelibrary.wiley.com/doi/10.1002/hpm.2707
Mohammed S, Bermejo JL, Souares A, Sauerborn R, Dong H. Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users’ perspectives. BMC Health Serv Res. 2013 Dec;13(1):502.
Odeyemi IA. Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration. Int J Equity Health. 2014;13(1):20.
Akeju DO, Oladapo OT, Vidler M, Akinmade AA, Sawchuck D, Qureshi R, et al. Determinants of health care seeking behaviour during pregnancy in Ogun State, Nigeria. Reprod Health. 2016 Jun;13(S1):32.
Tanyi PL, André P, Mbah P. Care of the elderly in Nigeria: Implications for policy. Tong K wai, editor. Cogent Soc Sci. 2018 Jan 1;4(1):1555201.
Kimani JK, Ettarh R, Kyobutungi C, Mberu B, Muindi K. Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey. BMC Health Serv Res. 2012 Dec;12(1):66.
Dror DM, Hossain SAS, Majumdar A, Pérez Koehlmoos TL, John D, Panda PK. What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis. Weary D, editor. PLOS ONE. 2016 Aug 31;11(8):e0160479.
Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy Plan. 2004 Sep 1;19(5):249–70.
Blanchet N, Fink J, Osei-Akoto I. The effect of Ghana’s National Health Insurance Scheme on health care utilisation. Ghana Med J. 2012;46(2):76–84.