Introduction: The Nigerian government has introduced various forms of health insurance programme as a means of supplying quality healthcare services to its citizens all in attempt to attain the universal health coverage. Unfortunately, these various forms of Social Health Insurance Programme (SHIP) have witnessed inefficiencies in the supply of healthcare services and this is evidenced by observed adverse selection and supplier induced demands which are major causes of market failure in health insurance industry. Therefore, there is a need to deduce unique strategies to improve supply of health insurance so as to reduce the barest minimum the incidence of market failure which has impacted negatively on the health insurance industry. Methods: The study adopted qualitative approach by using in-depth interviews (IDIs) method. Nine (9) key informants were purposely sampled from three (3) purposively selected hospitals, one from each categorized type of facility. Content analysis was adopted and further analysis was achieved with the aid of Nvivo 11 software, which coded and categorized nodes into themes. Results: The interviewees relayed their experiences in the programme which includes provider non-adherence to accreditation pattern, poor reimbursement and tariff structure, fluctuations in prices of input, inadequate funding of the programme and low number of enrollees registered in private facilities and consequently proffered strategies on how to eliminate adverse selection and supplier induced demand with a resultant improvement in supply of health insurance services. Conclusions: Evidence from this qualitative study have shown various strategies if implemented will reduce the incidence of adverse selection and supplier induced demand which are mostly implicated as common causes of market failures.
Introduction: The principle underpinning the Supply of health insurance services in Nigeria is that as prices increases, the healthcare provider makes more profit and will be motivated to provide more health insurance services to the enrollees. These supplies of health insurance services are therefore influenced by critical determinants that will either make the provider to supply health insurance services or withhold it. Therefore, there is a need to look at those critical factors that can hinder the supply of services in the programme. This study sets out to examine the effect of identified critical determinants on supply of services and also show how much these critical determinants can collectively predict this supply of services. Design/Methodology: This is a cross sectional study using a quantitative approach. Sample size was determined using Cochran formular and calculated sample size was forty six (46). Multistage sampling technique was adopted. Variables were analyzed using descriptive statistics and linear regression method with SPSS version 11. Result: The critical determinants of reimbursement structure, tariff structure, facility number of enrollees and cost of hospital consumables studied had positive impact on the supply of service but the impact of cost of hospital consumable was insignificant (>0.5). Similarly, 95% of changes in the supply of services can be accounted for significantly by the independent variables in this study (p=0.000). Conclusion: Evidences from this study have shown that most of the identified critical determinants studied had significant effect and also collectively could account significantly for changes in the supply of services and so therefore there is a need to properly address these factors so as to achieve the set out objectives in the programme.
Introduction: Social health insurance programme was initiated in Nigeria with one of the aims being to improve the demand for quality healthcare services with a resultant reduction in catastrophic spending among the citizenry. Unfortunately, in this programme, healthcare providers who offer quality healthcare services still witness poor enrollee demand for services which has led to inability of the programme to achieve its set out objectives. Hence, the need to study the effects of selected critical determinants on demand for health insurance services and how much these determinants can collectively account for the demand for services in the programme. Design/Methodology: The study adopted a cross sectional design with a quantitative approach. The sample size was calculated using G-Power 3.1 software and the determined sample for the study was one thousand four hundred and thirty five (1435). Multistage sampling method was adopted. Data was analyzed using descriptive statistics and linear regression method with the aid of SPSS version 11. Result: The critical determinants of provider ownership, distance to healthcare provider, enrollee educational level have significant positive effect on the demand for health insurance services (<0.05) but the effect of enrollee income was positively insignificant (>0.05). Similarly, 75% of the changes in demand for health insurance services can be accounted for by the predictor variables in this study. Conclusion: The inability of the programme to address these selected critical determinants significantly will lead to out of pocket spending for healthcare services with a resultant catastrophic effect on families' finances. Therefore, there is a need to take into account the effects of these determinants duringpolicy formulation, reviews and process implementation in the programme.
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