1Department of Community Health, Federal Medical Centre, Owo, Ondo State, Nigeria
2Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
3Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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.
Water HR, Anderson GF, Mays J. Measuring financial protection in health in the United States. Health Policy 2004; 69: 339–49. doi:10.1016/j.healthpol.2004.01.003
Ranson MK. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bull World Health Organ 2002; 80: 613–21.
Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ 2002; 80: 97–105.
Kawabata K, Xu K, Carrin G. Preventing impoverishment through protection against catastrophic health expenditure. Bull World Health Organ 2002; 80: 612.
Wagstaff A, Lindelowb M, Junc G, Lingc X, Jonchengc Q. Extending health insurance to the rural population: An impact evaluation of China’s new operative medical scheme. J Health Econ 2009; 28: 1–19.
Obikeze OO, Ige OK, Osungbade KO, Asuzu MC, Olumide AE. An overview of the National Health Insurance Scheme in Nigeria. Dokita 2010; 1: 15–21.
NHIS. National Health Insurance Scheme Handbook. Operational Guidelines on National Health Insurance Scheme. Federal Republic of Nigeria: Ministry of Health; 2006. doi: 10.4314/msjm.v3i1.10989
Soyibo A. National Health Accounts (NHA) of Nigeria. Federal Republic of Nigeria: Ministry of Health; 2009. doi: 10.4314/ajep.v14i1.44195
National Health Insurance Scheme (NHIS). Road map for the implementation of Community-based health insurance scheme in Nigeria. Consultation on Support to NHIS CBSHIS roll-out in Programme States. Abuja: PPRINN-MNCH/NHIS; 2011.
Nguyen HT, Rajkotia Y, Wang H. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts. Int J Equity Health 2011; 19: 4. doi: 10.1186/1475-9276-10-4
Obikeze E, Onwujekwe O, Uzochukwu B, Chukwuogo O, Uchegbu E, Soludo E, et al. Benefit incidence of national health insurance scheme in enugu state, Southeast Nigeria. African Journal Health Econ 2013; forthcoming.
Ilesanmi OS, Ige OK. Equity of care: A comparison of National Health Insurance Scheme enrolees and fee-paying patients at a private health facility in Ibadan, Nigeria. J Public Health Epidemiol 2013; 5: 51–5.
Akande TM, Ogunrinola EO. Health care financing among inpatients of a tertiary health facility in Ilorin, Nigeria. Niger J Clin Pract 2000; 2: 1–4.
Adinma B, Adinma E. Community based healthcare financing: An untapped option to a more effective healthcare funding in Nigeria. Niger Med J 2010; 51: 95–100.
Oyo State Health Facility Directory 2007. Ibadan: HMIS Department of Planning Research & Statistics Oyo State Ministry of Health; 2008.
Bender DR. A Refinement of the Concept of Household: Families, Co-residence, and Domestic Functions. Am Anthropol 1967; 69: 493–504. doi: 10.1525/aa.1967.69.5.02a00050
van Doorslaer E, O’Donnell O, Rannan-Eliya R, Somanathan A, Adhikari S, Garg C, et al. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 2006; 368: 1357–64. doi: 10.1016/s0140-6736(06)69560-3
O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: A guide to techniques and their implementation. Washington, DC: The World Bank; 2008. doi: 10.1596/978-0-8213-6933-3
Onoka CA, Onwujekwe OE, Hanson K, Uzochukwu BS. Examining catastrophic health expenditures at variable thresholds using household consumption expenditure diaries. Trop Med Int Health 2011; 16: 1334–1. doi: 10.1111/j.1365-3156.2011.02836.x
NPC, ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja: National Population Commission and ICF Macro; 2009.
Wagstaff A, Doorslaer E. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ 2003; 12: 921–33. doi: 10.1002/hec.776
Saksena P, Antunes AF, Xu K, Musango L, Carrin G. Mutual health insurance in Rwanda: evidence on access to care and financial risk protection. Health Policy 2011; 99: 203–9. doi: 10.1016/j.healthpol.2010.09.009
Onwujekwe O, Hanson K, Uzochukwu B. Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria. PLoS One 2012; 7: e40811. doi: 10.1371/journal.pone.0040811
Onwujekwe O, Okereke E, Onoka C, Uzochukwu B, Kirigia J, Petu A. Willingness to pay for community-based health insurance in Nigeria: do economic status and place of residence matter? Health Policy Plan 2009; 25: 155–61. doi: 10.1093/heapol/czp046
Ezeoke OP, Onwujekwe OE, Uzochukwu BS. Towards Universal Coverage: Examining Costs of Illness, Payment, and Coping Strategies to Different Population Groups in Southeast Nigeria. Am J Trop Med Hyg 2012; 86: 52–7. doi: 10.4269/ajtmh.2012.11-0090
Ekman B. Catastrophic health payments and health insurance: some counterintuitive evidence from low-income country. Health Policy 2007; 83: 304–13. doi: 10.1016/j.healthpol.2007.02.004