CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

A mixture of tax income, out-of-pocket costs, donation aid, and private benefits is funded by health care in Nigeria (social and community) (WHO, 2015). Nigeria's health spending, as compared to other African nations, is comparatively poor. Complete spending on health as a proportion of gross domestic product (GDP)from 2018 to 2000 was less than 5%, falling behind THE/GDP ratio in other developing countries such as Kenya (5.3%), Zambia (6.2%), Tanzania (6.8%), Malawi (7.2%), and South Africa (7.5%) (Soyinbo, 2015).Small structural capability, corruption, economic uncertainty and lack of political will have been described as reasons why certain health care funding systems in Nigeria have not succeeded effectively. (Adinma&Adinma, 2010).

Households face the largest burden of health spending in Nigeria. A analysis undertaken by Olakunde (2012) showed that the health funding structure is primarily marked by low government spending, high out-of-pocket costs, minimal benefit coverage, and low donor funding.Out-of-pockets obviously account for Nigeria's largest proportion of health spending. The higher proportion of overall health spending was out-of-pocket expenditure, averaging 64.59 percent from 2018 to 2017. (Soyinbo, 2015). It accounted for 74 percent of overall health spending in 2016(THE). In 2014, it declined to 66% and then rose to 68% in 2015. (Soyibo, Olaniyan & Lawanson, 2015).Since most Nigerians rely on their wallets to use health care, low-income groups such as the unemployed, the poor, the disabled, young people, housewives and illiterates are typically victims of circumstances that lead to low patronage of health facilities when ill-conditioned healthcare is required.This has contributed largely to the poor health indices in Nigeria particularly in areas of maternal and child mortality, HIV/AIDS, tuberculosis and life expectancy which obviously threaten the achievement of National health insurance scheme (NHIS) goal.Therefore, the government launched the National Health Insurance Scheme (NHIS) to ensure equal access to health care for all people, minimize undue dependency on government-owned health facilities and reinvigorate the declining health care financial structure, which is the type of health insurance to salvage the health situation and reduce the financial burden of the household in Nigeria.

Nigeria, like most other developing nations, implemented various initiatives aimed at achieving high living standards for its people at the time of independence in 1960. Up to the early 1980s, several construction plans were conceived and implemented. However, because of the uncertainty in the national political structure, the intended results of these steps were not optimally realized. The military's sporadic inroads into politics guaranteed the perversion of the ability of the people to live a decent life. Thus, economic mismanagement and oppressive governance witnessed the era (Ajakaiye, Taiwo and Chete, 2017).The mismanagement meant that the citizenry's abject poverty and low economic status contributed to the emasculation of most citizens and thereby increased the divide between rich and poor.Nigeria has historically ranked among the least in the quality of life assessment of population under the Human Development Index (HDI) of the United Nations Development Programme (UNDP).By the early 1990s, nearly all social services had declined, according to Agbakoba (2012). The health sector is one area of the economy that has struggled heavily. The World Bank (2010) estimates that Nigeria's per capita health investment was not only poor, but low in quality in the early 1990s. Nigeria's health spending of US$9 per person was much lower than in some other African nations, including Ghana (US$14) and Kenya (US$16). The net result of this was that child mortality was 11.4% in Nigeria in 1990, compared to 7.4% in Ghana and 5.7% in Kenya. Thousands of Nigerian infants have been malnourished and have been exposed to killer diseases such as measles, polio, whooping cough and diphtheria in the absence of sufficient immunization (Ehusani, 2012). The World Health Organization exposed the pitiful image of Nigeria's health sector, noting that the overall performance of the country's health system in 2000 was ranked 187th among the organization's 191 member states.(WHO, 2011).High child and maternal mortality and the prevalence of illnesses, many of which were of epidemic proportions, were the result of this. Malnutrition, iodine deficiency, low birth weight and stunting occurred. Life expectancy dropped to 48 years and the health-for-all illusion became a mirage by 2015. The condition in the sector was so serious that Dr. Agan, Chief Medical Officer, University Teaching Hospital, Calabar, observed that the distribution of health care in Nigeria was dead. (Vanguard, May, 17, 2012). Nigeria has one of Sub-Saharan Africa's lowest health care provider-to-patient ratios: 0.3 Doctors per 1000 people, 1.7 hospital beds per 1000 people, 1.7 Nurses, 0.02 Dentists, 0.05 Pharmacists, 0.91 Community Health Workers and 1.7 Midwives per 1000 people, respectively. (WHO,2016; Ogbolu2012).

Health insurance stands for a pooling of health costs in order to secure coverage for the participants regardless of the confusion underlying the prevalence of ill health and compensation for the care of that ill health. This is because, while it is predictable for big populations, the demand for health insurance is also extremely unexpected and very expensive for the client. It is possible to use premiums to distribute the premium load. In a number of forms, health care may be funded and coordinated. It can be acquired by a person or organization from profit or non-profit companies in the private sector and, under these cases, it is conventionally considered private or charitable health insurance.In general, compulsory insurance is administered by state bodies, although it can be administered by private insurance carriers, as is the case in the Netherlands with respect to civil servants. Community health insurance is a sub-type of universal health insurance that is typically part of a social welfare scheme financed by specific donations (mainly payroll) and operated by independent or quasi-autonomous sickness trusts, friendly societies or private insurers.In the other hand, optional (private) health care may be approved and paid for on behalf of people at the discretion of individuals or employers. Voluntary insurance can be sold, as is the case in Ireland, by a public or quasi-public body. Customers, manufacturers and third party financial institutions are the primary parties to the health insurance system (insurers). How they relate to each other determine the insurance plan. Depending on a country's concept of provider, providers include medical physicians, pharmacists, nurses, and other allied health professionals. Insurance agencies, illness trusts, charitable or quasi-public organizations, health maintenance organizations (HMOs) and friendly associations are third party financiers.

The Nigerian health care sector is an innovative driver that creates and widely disseminates modern, life-enhancing therapies and provides a wide variety of health care customer options. There are major advantages to the existing health care system, but there are tremendous possibilities for changes that will decrease prices, expand coverage, improve efficiency and improve the health of Nigerians.In several ways, the health of an individual can be sustained or enhanced, both by improvements in personal conduct and through the adequate consumption of health care services. Although there is tremendous spending on health care in Nigeria, the value of health gives a good justification for this amount of expenditure. However, since funding and delivery of health care are often inefficient, there are ways to improve health and access to health care services without further increase in spending.The Administration has adopted initiatives that will raise options for people to buy consumer-directed health insurance premiums in order to boost the effectiveness of health care funding and delivery.

The Administration has also sought to connect compensation from providers to results, thus rewarding successful health care delivery. In Presidentspeech, he suggested a reform in the tax status of health insurance, proposing a standard allowance for the purchase of health insurance for all Nigerians. Such a move may play an important role in strengthening the effectiveness of the Nigerian health care system and growing health insurance coverage. Health care has enhanced the health of our society not just through the utilization of health care facilities, but also through individual actions and lifestyle decisions such as avoiding smoking, consuming more nutritious foods, and having more exercise; better productivity in the health care system, however, could result in even greater health for Nigerians without increasing health care spending, Rapid growth in health care costs and limited access to health insurance continue to present challenges to the health care system.Administrations policies are aimed at reducing cost growth, increasing coverage and widening access to health care by relying on the private sector and market-based solutions. The need for health care is different from the demand for other consumer goods and services, since primary use is the need for consumer products and services, the desire for health care is not derived directly from the consumption of the medical procedures themselves; rather, it comes from the direct value of improved health that is produced by health care

In Nigeria, the influence of health insurance is being eroded by a failing economy. Health insurance impacts the customer's financial power, health status, and others, so it is important for people in Nigeria to be covered because it can help minimize the cost of disease treatment, improve access to health services, etc. This research focuses on the impact of insurance on health care services in Nigeria.

1.2 STATEMENT OF PROBLEM

Current findings have demonstrated that health insurance can be used to offset the poor consequences of high out-of-pocket health expenses.A high out-of-pocket payment is known to limit spending expenditure on other goods and services and thereby drive households into poverty by disastrous expenditure (Mathauer, Schmidt &Wenyaa, 2018).Health care insurance for all nations and all people has been a worldwide challenge. The ability of national governments to provide health care funding and retain funding is an immense responsibility, with Nigeria being no exception. Governments around the world are seeking modern and creative approaches to ensure that basic health coverage is available to everyone at reasonable rates and is equal. In funding healthcare programs, out-of-pocket costs are unreasonable and wasteful. This has adversely affected the use of healthcare facilities in Nigeria (Mathauer, Schmidt &Wenyaa, 2018). In Nigeria, the volume of out-of-pocket spending on healthcare remains strong. Currently, in Nigeria, 26.6 percent of overall health spending is out-of-pocket. This causes many individuals to poverty and poses an obstacle to access to healthcare as it quickly pushes disadvantaged families into poverty. Statistics suggest that, according to the WHO definition of poverty as surviving on one dollar or less a day, more than 46.6 percent of the Nigerian population is poor. (World Bank, 2010). The Ministry of Health reports that, due to financial restrictions, 15 percent of the poor do not pursue health insurance, while 38 percent of them always sell properties or borrow to cover medical bills. This has further moved 1.5% of households below the poverty line. (Nigerian government, Health Systems 2021 Project, 2015). Health insurance coverage is steadily increasing from 9.8% in 2015 to 25% of the overall Nigerian population in 2015. Compared to 41.5 per cent of the wealthy, only 2.9 percent of the poorest have any sort of cover. This is also small in light of the fact that health care is one of the health finance policy agenda that is set to lead the world towards the realization of universal health coverage (Mwaura, Barasa, Ramana, Coarasa&Rogo, 2015). Therefore this study centers on the impact of insurance on health services in Nigeria

1.3      OBJECTIVE OF THE STUDY

In line with the statement of research problems the objectives of the study are to determine the impact of insurance on health services in Nigeria

1) To examine the evolution of health insurance scheme in Nigeria

2)To examine the impact of health insurance on health services in Nigeria

3) To examine the forms of health insurance obtainable in Nigeria

4) To determine the prospects and challenges of health insurance in the delivery of health care services in Nigeria

5) To recommend solutions to the problems of health insurance in achieving a reliable health service in Nigeria

1.4 RESEARCH QUESTIONS

1) What is the evolution of health insurance scheme in Nigeria?

2) What is the impact of health insurance on health services in Nigeria?

3) What are the forms of health insurance obtainable in Nigeria?

4)What are the prospects and challenges of health insurance in the delivery of health care service in Nigeria?

5)What are the solutions to the problems of health insurance in delivery of a reliable health service in Nigeria?