Page 86 - GHES-2-4

Global Health Economics and
Sustainability
NHIS: Acceptability and preferred benefit package

Table 6. Average ranking of preferred NHIS benefit package by various socioeconomic classes
Variables Poorest Poor Middle Rich Richest χ (p‑value)
2
Package covering all services 4.19 (0.11) 4.49 (0.10) 4.10 (0.11) 4.10 (0.11) 4.02 (0.12) 20.22 (0.210)
Package covering only basic disease control services 1.66 (0.08) 1.57 (0.08) 1.78 (0.10) 1.95 (0.09) 2.20 (0.08) 50.66 (0.000)*
Package covering only outpatient services 1.54 (0.07) 1.56 (0.08) 1.57 (0.09) 1.87 (0.09) 2.06 (0.07) 50.88 (0.000)*
Package covering only inpatient services 1.53 (0.07) 1.53 (0.08) 1.50 (0.07) 1,84 (0.08) 1.94 (0.07) 37.26 (0.000)*
Package covering only emergency services 1.44 (0.06) 1.41 (0.06) 1.44 (0.07) 1.69 (0.07) 1.88 (0.06) 39.12 (0.000)*
*Statistically significant (p<0.05); χ =Chi-square. Notes: Except for χ (p-value), the corresponding data for every socioeconomic class is expressed as
2
2
mean (SD).
Abbreviation: NHIS: National Health Insurance Scheme.
the opportunity more than a third will not enroll for the 2021; Aregbeshola, 2018; Shobiye et al., 2021; Uzochukwu
NHIS, potentially affecting the program’s coverage. This et al., 2015). This shows that these respondents are aware of
result was lower than the proportion reported among the benefits of the social health insurance scheme and are
the informal sector in Rivers State (Anderson & Adeniji, likely to want to enroll in the scheme.
2019). The observed variation may be due to differences The preferred health benefits package in this study
in the studied population – one from formal sector while
the other from the informal sector. Another study among was that covering all types of care, including emergency,
federal civil servants in the state reported a higher level of inpatient, and outpatient care. This is understandable as
enrollment among them, indicating high-level acceptance, respondents want the best value for their money. Two out
especially since the scheme was not made mandatory of five of the respondents belong to the poorest and poor
(Adebiyi & Adeniji, 2021). Findings from this study were socioeconomic groups and they arguably want a scheme
similar to those reported among civil servants in Sokoto, that will give them financial risk protection. However,
northern Nigeria, potentially due to similarities in the no one package can cover all services as the scheme may
study groups (Ahmed & Aliyu, 2019). This is, however, not be able to afford and sustain the financial cost of
varied from a study that measured levels of acceptance of running such a service. Similar preferences have been
NHIS among clients already registered with the scheme. reported among respondents (Anderson & Adeniji, 2019;
The proportion with the highest level of acceptance was Onwujekwe et al., 2010). Likewise, a study in Kenya
lower than that of this study (Marvel, 2018). Another reported a preferred package that covered all types of
study among civil servants in Kwara State, North Central care including inpatient and outpatient care, drugs, and
Nigeria, reported an acceptance level lower than that of emergency care (Mulupi et al., 2013). However, this health
this study, which may be related to the economic downturn benefit package (type I) was not statistically associated
and unwillingness to deplete their much-needed fund in a with the socioeconomic status, as the poor and the poorest
contributory scheme (Omole et al., 2023). showed a high preference for this package.
Acceptability of the NHIS in this study was The next preferred health benefits package is that
significantly associated with socioeconomic status. covering care for basic diseases (type II). Respondents
Similar association has been reported by some studies probably viewed this package as a means to meet their
in the state, as those who earn less were reportedly more basic health needs and maybe a cost-cutting strategy aimed
likely to accept the scheme (Adebiyi & Adeniji, 2021; at meeting their immediate health needs while attempting
Anderson & Adeniji, 2019). However, a study among to reduce the premium paid since the participants in the
civil servants reported no association between income NHIS will pay out a portion of their salaries, albeit not set
and acceptance (Omole et al., 2023) at a fixed amount. This was the preferred package among
Among the respondents who found the insurance the rich. This finding was different from another study
schemes acceptable, more than half had a medium or that reported outpatient care only as the “next” preferred
high rating for the potentials of the scheme to provide benefit package (Onwujekwe et al., 2010). Another reason
financial risk protection, improve the level of access, for this preference could be the fact that it is the least
reduce health-care costs, improve quality of service, and expensive, aside from a general distrust for public-funded
ensure availability of drugs, all of these are known benefits health-care provision (Ahmed & Aliyu, 2019). Likewise,
of the social health insurance schemes with the potential to there is a preference for paying out of pocket for health
help achieve universal health coverage (Adebiyi & Adeniji, services received (Marvel, 2018).

Volume 2 Issue 4 (2024) 8 https://doi.org/10.36922/ghes.2909