Health insurance and user fees: a survey of health service utilization and payment method in Mushin lga, Lagos, Nigeria

Background: Studies have documented how out-of-pocket payments (OOP) and user fees result in catastrophic health expenditures, providing evidence that health systems are better financed through prepayment mechanisms such as health insurance. Aim: This study sought to determine the perception of community residents to health insurance, their pattern of health service utilization and method and amount of payment. Methods: This descriptive cross-sectional study among 422 household members in Mushin LGA obtained data on sociodemographic characteristics, perception of health insurance, enrollment status and willingness to enroll; last use of health services and method of payment for health care services. Data analysis was done with Epi-info (ver 7) and results were presented as frequencies, percentages, means and standard deviations. Statistically significant associations were determined using the Chi-square test at significance level of p < 0.05. Results: Over half the respondents (56.6%) had not heard about health insurance. Very few (19.7%) were enrolled. Of those not enrolled, 57.1% were willing to consider buying health insurance. The method of payment for health services reported by respondents was OOP (98.3%). Those in younger age groups, with higher levels of education and higher household incomes reported having heard of health insurance. Higher educational level and household incomes were positively associated with willingness to enroll in a health insurance scheme. Conclusion: Awareness was insufficient, health services were paid for mostly from OOP. The authors recommend taking the opportunity to encourage uptake of health insurance for young adults and those in low- and middle-income households

Impact of Health insurance.

The cost of medical care is skyrocketing daily which is unaffordable for the common man.The number of corporate hospitals in the country is increasing; small hospitals and nursing homes which were catering to the middle class people are almost on the verge of vanishing. There is also mushrooming and competition seen among health insurance providers. The common man without insurance coverage finds it very difficult to afford the high cost of healthcare.The doctor’s approach towards the insured patient changes automatically and he quickly responds in a different way.Millions of people fearing such a type of approach by the doctors and the heavy bills of hospitals have ended up taking the insurance coverage. Rising above commercial considerations, doctors should be more cautious and judicious in managing patients irrespective of their insurance coverage. Awareness must be created among the general public about aggressive management.

Awareness and Willingness Regarding Community Based Health Insurance in Urban Slums and Resettlement Colonies.

Health insurance is an efficient way to help people prepare for contingency health care. Health care would be more equitable under community-based insurance than the out-of-pocket system. Such a scheme is especially important for the marginalized population. Objective: To study the awareness and willingness to participate in a community-based scheme among the families. Study Design: Cross-sectional community based. Setting: Urban slums and resettlement colonies in East Delhi. Participants: Head of families or available adult member of 510 families. Statistical Analysis: Proportions, Chi square test. Results: Most of the families had a per capita income of Rs.200-600 per month. Average out-of-pocket expenditure on healthcare per person per month was Rs.38.50. Nearly one-fourth of the families had some hospitalization in past 6 months, with loss of man-days and loss of wages. More than three-fourths of the respondents were aware about ‘insurance’, believed that health insurance is beneficial, and expressed willingness to participate. There is a need for health insurance among this population, and with government assistance and proper planning and education, community-based health insurance can possibly help these families manage their health care costs better.