Achieving financial risk protection through a national Social Health Insurance Programme in Nigeria: Perspectives of enrollees and healthcare providers

• Published in: The International journal of health planning and management 2020-07, Vol.35 (4), p.859-866
• Main Authors: Ebunoha, Gladys N., Ughasoro, Maduka D., Nwakoby, Ifeoma C., Onwujekwe, Obinna E.
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Data collection; Expenditures; Female; Financing, Personal; Health administration; Health care; Health care expenditures; Health insurance; Health Knowledge, Attitudes, Practice; Humans; Insurance; Male; Medical personnel; Middle Aged; National health insurance; Nigeria; Primary care; Risk Assessment - economics; Social health insurance; Surveys and Questionnaires; universal financial risk protection; Universal Health Coverage; Universal Health Insurance - economics
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.2949

Summary Introduction Out‐of‐pocket (OOP) payment adversely affects universal financial risk protection (UFRP) and the achievement of Universal Health Coverage (UHC). Since the introduction of a Formal Sector Social Health Insurance Programme (FSSHIP) in Nigeria, the extent to which it has provided UFRP is still largely unknown. This study therefore assessed this from the perspectives of both enrollees and healthcare providers. Methods The study was undertaken in Enugu state, Nigeria. The subjects were randomly selected primary enrollees and health care providers. An interviewer‐administered questionnaire was used for data collection on service utilization under the FSSHIP, as well as out‐of‐pocket payment of healthcare expenditure. Results Out of 333 formal sector workers interviewed, 283 (85%) were registered in the FSSHIP and 61.1% of them utilized FSSHIP. Among these, 89.8% of them used OOP to pay for about 95.2% of the healthcare expenditure. From the perspectives of the providers, 97.6%, patients still paid using OOP. Conclusion The FSSHIP is not providing UFRP as expected. This weakens the effectiveness of the FSSHIP to ensure UFRP and ultimately UHC. The NHIS should modify the FSSHIP to provide UFRP and eliminate both the high level of OOP and the proportion of expenditure it covers.