Background: Public health insurance schemes can offer households financial protection against health care costs and help to resolve inequality in health care provision. The current study evaluates the impact of the Nigerian National Health Insurance Scheme (NHIS) in reducing financial hardship for a sample of Nigerian households working in the health and higher education sectors. The data allows us to examine the variation in the financial protection effects across different income groups and explore differences in standard of living by households with coverage and those without.
Methods: Data was gathered in Akwa Ibom state, Nigeria. A cluster sampling technique is used to compare participants and non-participants in the NHIS and within this, identify equivalent groups with regard to household characteristics such as education level, income and household composition. A regression approach examines variations in out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and number of household assets across the insured and uninsured groups controlling for cofounding factors.
Results: The likelihood of experiencing CHE for a household that is insured is estimated to be 76% lower than that of an insured household, even after controlling for our variety of observable characteristics. OOPEs are 126% lower in households with insurance compared to those without. Our results also point to the heterogeneous effect of insurance across income groups. The likelihood of experiencing CHE for a household in the lowest income quartile that is insured is 83% lower than that of an insured household in the same income group, but a similar figure of 70% those in the highest income group. We additionally find a significant difference in standard of living, as measured by household asset ownership across the insured and non-insured groups
Conclusions: There is a statistically and practically significant association between participation in the NHIS scheme and household financial protection. Interestingly, the financial protection effect of Nigeria’s public health insurance scheme may be more concentrated in the lower end of the income distribution. This provides support to policy-makers seeking to design and extend equitable health-financing policies.