Project – Health Insurance Schemes and Access to Health care services in Nigeria

CHAPTER ONE

INTRODUCTION

• Background to the Study

Health insurance schemes have been introduced globally as mechanisms to improve financial access to health care services, especially in low- and middle-income countries. In Nigeria, the National Health Insurance Scheme (NHIS) was officially launched in 2005 to enhance equitable access to health care services and reduce out-of-pocket expenditures (Onwujekwe et al., 2019). Before the introduction of the NHIS, health care financing in Nigeria was predominantly out-of-pocket, which created significant barriers for the low-income population. However, despite the NHIS and other state-level initiatives, health care coverage remains low, and financial barriers persist, indicating that the impact of these schemes has been mixed.

Several studies have highlighted that awareness and enrollment in health insurance schemes are major determinants of access to health care in Nigeria. Research by Odeyemi and Nixon (2013) found that many Nigerians were either unaware of the NHIS or misunderstood its benefits, leading to low enrollment rates. Furthermore, enrollment has been largely limited to federal government employees and formal sector workers, excluding the informal sector and rural populations where the majority reside (Uzochukwu et al., 2015). Consequently, there is a significant disparity in access to health care services between insured and uninsured populations.

Access to health services among those covered by health insurance schemes has improved in several measurable ways. Studies have shown that insured individuals are more likely to seek medical care when ill and less likely to delay or forgo care due to financial constraints (Obikeze et al., 2020). Health insurance coverage has been associated with increased utilization of antenatal, maternal, and child health services. Nevertheless, concerns about the quality of services received under the scheme persist, with complaints ranging from delayed treatments to discrimination against insured patients (Umeh & Rogstad, 2017).

State-level initiatives have also tried to bridge the coverage gap. Various states in Nigeria, such as Lagos and Kwara, have launched their own health insurance programs targeting informal sector workers and rural dwellers (Adebayo et al., 2015). These community-based health insurance schemes have shown some promise in increasing access to health services among traditionally underserved populations. However, sustainability issues, inadequate funding, and limited provider networks remain significant challenges that must be addressed to scale these programs effectively.

Several structural and systemic barriers continue to undermine the effectiveness of health insurance schemes in Nigeria. Weak regulatory frameworks, poor administrative capacity, corruption, and inadequate health infrastructure particularly in rural areas have all contributed to limited improvements in health care access (WHO, 2018). Moreover, the fragmented nature of health insurance schemes across different states without a national harmonization strategy limits their potential to achieve universal health coverage (UHC) goals. Efforts to integrate schemes and introduce mandatory health insurance policies have been proposed as ways to enhance reach and efficiency.

In conclusion, while health insurance schemes in Nigeria have had some positive impact on access to health care services, they are far from achieving universal coverage or equity. The existing schemes tend to benefit a small, predominantly urban, and formally employed population segment. To enhance access to health care services nationally, policy reforms focusing on expanding coverage, improving service quality, increasing public awareness, and strengthening regulatory and administrative frameworks are essential. Future research should focus on evaluating recent policy changes and innovative models to achieve broader and more equitable health coverage.

• Statement of the Problem

Access to affordable and quality health care remains a significant challenge for the majority of Nigerians. Despite the introduction of the National Health Insurance Scheme (NHIS) and several state and private initiatives aimed at reducing the financial burden of health services, out-of-pocket expenditure still accounts for a significant portion of health care financing in Nigeria. This heavy reliance on direct payments at the point of service has resulted in widespread financial hardship, delayed health-seeking behavior, and poor health outcomes, particularly among low-income and vulnerable populations.

The National Health Insurance Scheme, launched in 2005, was intended to provide universal health coverage and equitable access to health services across the country. However, almost two decades later, coverage remains extremely low, reportedly covering less than 10% of the Nigerian population, most of whom are formal sector employees. The vast majority of Nigerians, especially those in the informal sector and rural areas, remain uninsured and continue to face significant barriers to accessing necessary health services. This situation undermines the goals of Universal Health Coverage (UHC) and the broader health and development objectives outlined in Nigeria’s national policies and international commitments.

Furthermore, even among those enrolled in health insurance schemes, access to quality health services is not guaranteed. Reports of poor quality of care, discrimination against insured patients, limited service packages, and inefficiencies in claims processing are prevalent. These deficiencies discourage enrollment and undermine public trust in the health insurance system. Thus, while insurance coverage is theoretically a tool for improving access to care, in practice it often falls short of delivering meaningful improvements in health service utilization and quality.

Another critical issue is the fragmentation and lack of coordination between different health insurance initiatives at the federal and state levels. Many states have set up their own health insurance schemes without harmonization or clear guidelines on integration with the national scheme. This has led to duplication of efforts, inefficiencies, and confusion among potential beneficiaries. Additionally, the absence of mandatory enrollment policies and weak enforcement mechanisms further impede the expansion of health insurance coverage in Nigeria.

Structural and systemic barriers such as poverty, illiteracy, weak health infrastructure, corruption, and poor health financing policies also exacerbate the problem. Health insurance schemes alone cannot address these deep-rooted challenges without broader health system reforms. There is an urgent need to critically examine the performance of existing health insurance schemes and identify sustainable, context-appropriate solutions that ensure equitable access to quality health services for all Nigerians, regardless of their socio-economic status or geographic location.

In summary, while health insurance schemes in Nigeria have been established to improve access to health care services, significant challenges persist. Low coverage rates, limited access for informal and rural populations, poor service quality, fragmentation of schemes, and structural barriers continue to undermine the effectiveness of these initiatives. Without comprehensive reforms and strategic policy actions, Nigeria will struggle to achieve the universal health coverage targets essential for improving population health and economic development.

1.3. Aim and Objectives of the Study

The aim of the study is to examine Health Insurance Schemes and Access to Health care services in Nigeria. The specific objectives are:

1. To assess the current landscape of health insurance schemes available in Nigeria.
2. To examine the level of awareness and utilization of health insurance among the Nigerian population.
3. To evaluate the impact of health insurance on access to healthcare services in Nigeria.
4. To identify barriers to accessing healthcare services in Nigeria, particularly for those without health insurance.

1.4. Research Questions

The research questions are buttressed below:

1. What is the current landscape of health insurance schemes available in Nigeria?
2. How aware are the Nigerian population of health insurance and how is it being utilized?
3. What is the impact of health insurance on access to healthcare services in Nigeria?
4. What are the barriers to accessing healthcare services in Nigeria, especially for those without health insurance?

1.5. Research Hypothesis

The hypothetical statement of the study is buttressed below:

Ho: Health insurance has no significant impact on access to healthcare services in Nigeria

H1: Health insurance has significant impact on access to healthcare services in Nigeria

1.6. Significance of the Study

This study is significant because it addresses one of the most pressing health policy issues in Nigeria—equitable access to health care services. With a large proportion of the population still paying out-of-pocket for health services, understanding the effectiveness and limitations of health insurance schemes is crucial for reducing financial barriers to care. By examining the impact of health insurance on access to services, this research contributes valuable insights into the broader effort to improve public health outcomes and reduce health-related poverty in Nigeria.

The study holds practical importance for policymakers and health system planners. Findings from this research can inform strategies to enhance the performance of existing health insurance programs such as the National Health Insurance Scheme (NHIS) and state-level health insurance agencies. Evidence-based recommendations from the study can help shape future reforms aimed at expanding coverage, improving service quality, and integrating schemes more effectively to move toward Universal Health Coverage (UHC).

Furthermore, this study is particularly relevant for stakeholders in the informal sector, who currently make up the majority of Nigeria’s population but remain largely excluded from formal health insurance schemes. By analyzing the barriers to their inclusion and potential solutions, the research can help identify ways to reach underserved populations. This is essential for promoting equity in the health system and ensuring that health insurance schemes fulfill their mandate of inclusivity.

Academically, this study contributes to the growing body of literature on health financing in low- and middle-income countries, especially within the sub-Saharan African context. It provides an up-to-date, Nigeria-specific perspective that is essential for comparative studies, regional health planning, and global health discussions on best practices in health insurance implementation. It also highlights areas requiring further academic inquiry, such as the role of digital platforms in expanding coverage and the impact of community-based health insurance models.

For development partners, non-governmental organizations, and donor agencies engaged in Nigeria’s health sector, the study offers critical data that can guide funding priorities, technical assistance, and program designs. Understanding the limitations and potential of Nigeria’s health insurance landscape allows these actors to align their interventions more effectively with national health goals and community needs.

Lastly, the study is beneficial to the general public, especially those seeking to better understand how health insurance schemes function and how they can benefit from them. Increased awareness and knowledge about health insurance could lead to more informed health-seeking behavior and greater demand for accountability from health care providers and insurance administrators. Ultimately, the study aims to serve as a catalyst for more inclusive, efficient, and effective health insurance systems that ensure no Nigerian is left behind in accessing essential health care.

1.7. Scope of the Study

The study examines Health Insurance Schemes and Access to Health care services in Nigeria. A study of AXA Mansard Insurance, Lagos.

1.8. Operational Definition of Terms

1. Health Insurance Schemes: Health insurance schemes are organized systems—typically run by the government, private sector, or community groups—that pool funds to cover the cost of medical care for their members. These schemes aim to protect individuals from high out-of-pocket health expenses and improve access to health services by spreading financial risk across a larger group.
2. Access (in the context of health care): Access refers to the ability of individuals to obtain and make use of needed health care services. It includes physical availability, financial affordability, acceptability, and timeliness of services. True access means not only that services exist, but that people can reach and effectively use them without unnecessary barriers.
3. Health Care Services: Health care services include a wide range of medical, preventive, diagnostic, therapeutic, and rehabilitative services provided by health professionals and facilities. These services are aimed at maintaining or improving a person’s health and can be delivered in hospitals, clinics, health centers, or at home.
4. Insurance: Insurance is a financial arrangement in which individuals or groups pay regular premiums to a company or organization, which then provides financial compensation or coverage for specific risks or losses, such as illness, accidents, or property damage. In health insurance, it involves covering the costs of medical care.
5. Health: Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity (as defined by the World Health Organization). It encompasses various dimensions of life that contribute to a person’s overall quality of life.

Project – Health Insurance Schemes and Access to Health care services in Nigeria