Predictors of Enrolment in the National Health Insurance Scheme Among Women of Reproductive Age in Nigeria

Abstract

Background: Despite the implementation of the National Health Insurance Scheme (NHIS) since 2005 in Nigeria, the level of health insurance coverage remains low. The study aims to examine the predictors of enrolment in the NHIS among women of reproductive age in Nigeria. Methods: Secondary data from the 2013 Nigeria Demographic and Health Survey (NDHS) were utilized to examine factors influencing enrolment in the NHIS among women of reproductive age (n=38 948) in Nigeria. Demographic and socio-economic characteristics of women were determined using univariate, bivariate and multivariate analyses. Data analysis was performed using STATA version 12 software. Results: We found that 97.9% of women were not covered by health insurance. Multivariate analysis indicated that factors such as age, education, geo-political zone, socio-economic status (SES), and employment status were significant predictors of enrolment in the NHIS among women of reproductive age. Conclusion: This study concludes that health insurance coverage among women of reproductive age in Nigeria is very low. Additionally, demographic and socio-economic factors were associated with enrolment in the NHIS among women. Therefore, policy-makers need to establish a tax-based health financing mechanism targeted at women who are young, uneducated, from poorest households, unemployed and working in the informal sector of the economy. Extending health insurance coverage to women from poor households and those who work in the informal sector through a tax-financed non-contributory health insurance scheme would accelerate progress towards universal health coverage (UHC).

Spatial distribution and associated factors of health insurance coverage in Ethiopia: further analysis of Ethiopia demographic and health survey, 2016

“…Being a worker was a significant predictor of health insurance coverage among women in this study. This finding is consistent with similar studies done in Africa [15,26]. The possible reason could be employed women are economically empowered to pay premium contributions than the unemployed once.…”

“…Consistent with previous studies [13,[15][16][17], the current study showed that the likelihood of being covered by health insurance was highest among educated women as compared with women with no education. The possible explanation could be educated women have more knowledge about the advantages of health insurance and make informed choices, engage themselves in different knowledge enhancement activities like reading materials, give more concern for their health and insure themselves against the unexpected out-of-pocket payments.…”

“…Even though, health insurance schemes designed to help ease the financial burden on the poorest households, the finding of this study revealed that the odds of health insurance coverage was higher among women in the richest wealth quintile. This finding is consistent with those from other settings elsewhere [13,[15][16][17]26]. This could be households with high wealth quantiles often have more income to afford health insurance premium compared to the poor once.…”

“…Relatively older women were more likely to have health insurance coverage as compared to younger women. Similar studies have also reported a direct relationship between maternal age and health insurance coverage [13,15,17]. This could be explained by as maternal age increases, their health status deteriorates.…”

“…Age, level of education, residence, wealth status, travel cost, travel time, exposed to media and occupation of the mother were factors influencing variations in health insurance coverage in Ethiopia [13][14][15][16][17][18][19].…”