National Health Insurance Scheme: How Protected Are Households in Oyo State, Nigeria from Catastrophic Health Expenditure?

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 ۷۱۴ households in urban communities of Oyo State. CHE was measured using a threshold of ۴۰% 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 ۳۳.۵ years. The median household income was ۴۳,۵۰۰ naira (۲۹۰ US dollars) and the range was ۷,۰۰۰–۶۸۰,۰۰۰ naira (۴۶.۷–۴,۵۳۳ US dollars) in ۲۰۱۲. The overall median household healthcare cost was ۸۹۰ naira (۵.۹ US dollars) and the range was ۱۰-۱۷,۷۰۰ naira (۰.۱–۱۱۸ US dollars) in ۲۰۱۲. In all, ۶۷ (۹.۴%) households were enrolled in NHIS scheme. Healthcare services was utilized by ۶۳۷ (۸۲.۹%) and CHE occurred in ۴۲ (۶.۶%) households. CHE occurred in ۱۴ (۱۰.۹%) of the households in the lowest quintile compared to ۳ (۲.۵%) in the highest wealth quintile (P= ۰.۰۰۴). The odds of CHE among households in lowest wealth quintile is about ۵ times. They had Crude OR (CI): ۴.۷ (۱.۳–۱۶.۸), P= ۰.۰۲۲. 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.

Keywords:

National Health Insurance Scheme (NHIS) , Catastrophic Health Expenditure (CHE) , Households , Wealth Quintiles , Cost , Healthcare Utilization