User experience with a health insurance coverage and benefit-package access: implications for policy implementation towards expansion in Nigeria.
BACKGROUND
Developing countries are devising strategies and mechanisms to expand coverage and benefit-package access for their citizens through national health insurance schemes (NHIS). In Nigeria, the scheme aims to provide affordable healthcare services to insured-persons and their dependants. However, inclusion of dependants is restricted to four biological children and a spouse per user. This study assesses the progress of implementation of the NHIS in Nigeria, relating to coverage and benefit-package access, and examines individual factors associated with the implementation, according to users' perspectives.


METHODS
A retrospective, cross-sectional survey was done between October 2010 and March 2011 in Kaduna state and 796 users were randomly interviewed. Questions regarding coverage of immediate-family members and access to benefit-package for treatment were analysed. Indicators of coverage and benefit-package access were each further aggregated and assessed by unit-weighted composite. The additive-ordinary least square regression model was used to identify user factors that may influence coverage and benefit-package access.


RESULTS
With respect to coverage, immediate-dependants were included for 62.3% of the users, and 49.6 rated this inclusion 'good' (49.6%). In contrast, 60.2% supported the abolishment of the policy restriction for non-inclusion of enrolees' additional children and spouses. With respect to benefit-package access, 82.7% of users had received full treatments, and 77.6% of them rated this as 'good'. Also, 14.4% of users had been refused treatments because they could not afford them. The coverage of immediate-dependants was associated with age, sex, educational status, children and enrolment duration. The benefit-package access was associated with types of providers, marital status and duration of enrolment.


CONCLUSIONS
This study revealed that coverage of family members was relatively poor, while benefit-package access was more adequate. Non-inclusion of family members could hinder effective coverage by the scheme. Potential policy implications towards effective coverage and benefit-package access are discussed.
Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany, Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany, shafiudot@gmail.com.
Shafiu
S
Mohammed
Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany, School of Public Health, Faculty of Medicine and Health Sciences, Jenderal Soedirman University, Purwokerto, Central Java, Indonesia.
Budi
B
Aji
Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany and.
Justo Lorenzo
JL
Bermejo
Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany.
Aurelia
A
Souares
Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany, Center for Health Policy Studies, Zhejiang University School of Medicine, Zhejiang, China.
Hengjin
H
Dong
Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany.
Rainer
R
Sauerborn
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D009313:National Health Programs; D009549:Nigeria; D017060:Patient Satisfaction; D012189:Retrospective Studies; D055815:Young Adult
Access; coverage; evaluation; health insurance; health policy; implementation