title: Who benefits from the Obio Community Health Insurance Scheme in Rivers State, Nigeria? A benefit incidence analysis.
abstract: A key aspect of monitoring and evaluating health programs is ensuring that benefits are reaching their target population. We conducted a benefit incidence analysis (BIA) of a Shell-sponsored community health insurance scheme in Nigeria to determine the extent to which the target group (the poor) was benefitting.
  
  
  
  We examined a sample of 616 patients' hospital attendance, financial and administrative records from 2012-2013. We estimated annual utilization rates and average unit costs for inpatient and outpatient services. We multiplied the two to produce a total cost per patient, then deducted annual out-of-pocket expenditures to estimate the total community-based health insurance scheme benefit per person. Benefits were multiplied by the total number of persons in each socioeconomic group to aggregate benefits. We used concentration curves and dominance tests to determine statistical significance at 5% and 10% levels of significance.
  
  
  
  Collectively, the poorest 20% of the population received 12% of benefits while the richest quintile received the largest share (23%). Inpatient and outpatient benefits are weakly regressive (pro-rich), statistically significant at a 10% level of significance.
  
  
  
  Although the poor were found to benefit, this BIA revealed a tendency towards pro-rich distributions. Removing co-payments for the poorest, reducing long wait and visit times and using community volunteers to help increase access to health services may improve benefits for the poor.
authors.affiliation: Royal Tropical Institute (KIT), Amsterdam, The Netherlands 1090HA kelsey@bangforbuckconsulting.com.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Vaughan
authors.affiliation: ENAULD Health Research and Services, Leidschendam, The Netherlands 2264BC.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Akwataghibe
authors.affiliation: Shell Petroleum Development Company, Nigeria.
authors.forename: Babatunde
authors.initials: B
authors.lastname: Fakunle
authors.affiliation: Royal Tropical Institute (KIT), Amsterdam, The Netherlands 1090HA.
authors.forename: Liezel
authors.initials: L
authors.lastname: Wolmarans
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D002391:Catchment Area, Health; D003365:Costs and Cost Analysis; D005260:Female; D005102:Health Expenditures; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D008297:Male; D009549:Nigeria; D011203:Poverty; D012111:Residence Characteristics; D012923:Social Class
keywords: BIA; Benefit incidence analysis; CHIS; Community-based health insurance; Nigeria