Equitable health care financing and universal health care coverage in Nigeria

Abstract

Background: Out-of-pocket payments (OOP) can impose financial hardship and limit the utilization of medical care. In countries where the OOP is the major source of health care financing and prepayment mechanism of health insurance is underdeveloped it can further impoverish already poor households. This realization has generated interest in the equity implication of the social health insurance contributions. This is imperative when considering universal health care coverage especially for the poor.

Methods: Data for the study was obtained from three sets of the General Household Survey (GHS) panel, 2010/2011, 2012/2013 and 2015/2016. Two measures of health care financing: out of pocket payments (OOP) and health insurance contribution (HIC) by those enrolled in the National Health Insurance Scheme (NHIS) were employed in the analysis. The ability to pay measure was household consumption expenditure. Equity implication of the financing options was analysed using the Kakwani Progressivity Index, Lorenz and concentration curves and the Multiple Comparison Estimation Technique.

Findings: For the three periods the KPI estimates for the OOP (-0.035, -0.12, -0.097) were significantly negative (regressive). In 2012, the KPI estimate for the HIC (-0.037) though negative was not statistically significant (proportional) and the estimate (-0.18) was regressive in 2015. This suggest that in Nigeria the poor bear the burden of health care financing.

Conclusion: Efforts should be aimed at reducing the share of out-of-pocket payments for health care and provide financial protection for the poor. This can be achieve through improving the operations of the National Health Insurance scheme (NHIS).