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Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria.

ABSTRACT: BACKGROUND: It is important that community-based health insurance (CBHI) schemes are designed in such a way as to ensure the relevance of the benefit packages to potential clients. Hence, this paper provides an understanding of the preferred benefit packages by different economic status groups as well as urban and rural dwellers for CBHI in Southeast Nigeria. METHODS: The study took place in rural, urban and semi-urban communities of south-east Nigeria. A questionnaire was used to collect information from 3070 randomly picked household heads. Focus group discussions were used to collect qualitative data. Data was examined for links between preferences for benefit packages with SES and geographic residence of the respondents. RESULTS: Respondents in the rural areas and in the lower SES preferred a comprehensive benefit package which includes all inpatient, outpatient and emergencies services, while those in urban areas as well as those in the higher SES group showed a preference for benefit packages which will cover only basic disease control interventions. CONCLUSION: Equity concerns in preferences for services to be offered by the CBHI scheme should be addressed for CBHI to succeed in different contexts.

SUBMITTER: Onwujekwe O

PROVIDER: S-EPMC2896948 | biostudies-literature | 2010

REPOSITORIES: biostudies-literature

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Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria.

Onwujekwe Obinna O Onoka Chima C Uguru Nkoli N Nnenna Tasie T Uzochukwu Benjamin B Eze Soludo S Kirigia Joses J Petu Amos A

BMC health services research 20100612

<h4>Background</h4>It is important that community-based health insurance (CBHI) schemes are designed in such a way as to ensure the relevance of the benefit packages to potential clients. Hence, this paper provides an understanding of the preferred benefit packages by different economic status groups as well as urban and rural dwellers for CBHI in Southeast Nigeria.<h4>Methods</h4>The study took place in rural, urban and semi-urban communities of south-east Nigeria. A questionnaire was used to c ...[more]

PMID: 20540787

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Project description:BACKGROUND: Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community health insurance program might be used to improve patients' access to care. The operational research project "QUality Improvement Cardiovascular care Kwara - I (QUICK-I)" aims to assess the feasibility of CVD prevention care in rural Nigeria, according to international guidelines, in the context of a community based health insurance scheme. METHODS/DESIGN: DESIGN: prospective observational hospital based cohort study. SETTING: a primary health care centre in rural Nigeria. STUDY POPULATION: 300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD) who are enrolled in the Hygeia Community Health Plan. MEASUREMENTS: demographic and socio- economic data, physical and laboratory examination, CVD risk profile including screening for target organ damage. MEASUREMENTS will be done at 3 month intervals during 1 year. Direct and indirect costs of CVD prevention care will be estimated. OUTCOMES: 1) The adjusted cardiovascular quality of care indicator scores based on the "United Kingdom National Health Services Quality and Outcome Framework". 2) The average costs of CVD prevention and treatment per patient per year for patients, the clinic and the insurance company. 3) The estimated net health care costs of standard CVD prevention care per quality-adjusted life year gained. ANALYSIS: The primary outcomes, the score on CVD quality indicators and cost data will be descriptive. The quality scores and cost data will be used to describe the feasibility of CVD prevention care according to international guidelines. A cost-effectiveness analysis will be done using a Markov model. DISCUSSION: Results of QUICK-I can be used by policy makers and professionals who aim to implement CVD prevention programs in settings with limited resources. The context of the insurance program will provide insight in the opportunities community health insurance may offer to attain sustainable chronic disease management programs in low resource settings. TRIAL REGISTRATION: This protocol has been registered at ISRCTN, ID number: ISRCTN47894401.

Project description:IntroductionMoving towards the goal of universal health coverage requires strengthening service delivery and overcoming significant financial barriers. The Government of Ethiopia is rolling out community based health insurance to protect the rural community from high out of pocket health expenditure and improve health service utilization. We investigated the effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia.MethodsA community based cross sectional study was conducted. A Multi stage sampling technique was used to get a total of 454 (224 insured and 230 uninsured) households. The data were entered using EPI info version 7 and analyzed using SPSS version 20 and STATA version 13 for binary logistic regression analysis and propensity score matching analysis respectively. Wealth status of the households was computed by Principal Component Analysis (PCA). A multivariable logistic regression analysis was done to identify the predictors of catastrophic health expenditure. Propensity score matching analysis was used to determine the effect of community based health insurance on catastrophic health expenditure. The average treatment effect on the treated (ATT) was calculated to compare the means of outcomes across insured and uninsured households.ResultsA total of 454 household heads were included in the study, making a response rate of 91.2%.The total level of catastrophic health expenditure was found to be 20%. Among the households with catastrophic health expenditure, 4.41% were insured, whereas the remaining 15.64% were noninsured. Insured households (AOR = 0.19, 95% CI: 0.11-0.34), rich households (AOR = 1.98; 95% CI: 1.07-3.66), having member with chronic illness (AOR = 2.13, 95% CI: 1.01-4.51) and having member encountered any illness during the past 3 months (AOR = 2.44, 95% CI: 1.35-4.40) were statistically associated with catastrophic health expenditure. Community based health insurance contributed to 23.2% (t = -5.94) (95% CI: -0.31_-0.15) reduction of catastrophic health expenditure.ConclusionThe overall level of catastrophic health expenditure was high among noninsured households. Community based health insurance has significant financial protection from catastrophic health expenditure in northeast Ethiopia. Thus, the government need to scale up community based health insurance to protect the noninsured households from catastrophic health expenditure.

Project description:BackgroundTo accelerate universal health coverage, Nigeria's National Health Insurance Scheme (NHIS) decentralized the implementation of government health insurance to the individual states in 2014. Lagos is one of the states that passed a State Health Insurance Scheme into law, in order to expand the benefits of health insurance beyond the few residents enrolled in community-based health insurance programs, commercial private health insurance plans or the NHIS. Public and private healthcare providers are a critical component of the Lagos State Health Scheme (LSHS) rollout. This study explored the determinants and perception of provider participation in health insurance programs including the LSHS.MethodsThis study used a mixed-methods cross sectional design. Quantitative data were collected from 60 healthcare facilities representatively sampled from 6 Local Government Areas in Lagos state. For the qualitative data, providers were interviewed using structured questionnaires on selected characteristics of each health facility in addition to the managers' opinions about the challenges and benefits of insurance participation, capacity pressure, resource availability and financial management consequences.ResultsA higher proportion of provider facilities participating in insurance relative to non-participating facilities were larger with mid to (very) high patient volume, workforce, and longer years of operation. In addition, a greater proportion of private facilities compared to public facilities participated in insurance. Furthermore, a higher proportion of secondary and tertiary facilities relative to primary facilities participated in insurance. Lastly, increase in patient volume and revenue were motivating factors for provider facilities to participate in insurance, while low tariffs, delay and denial of payments, and patients' unrealistic expectations were mentioned as inhibiting factors.ConclusionFor the Lagos state and other government insurance schemes in developing countries to be successful, effective contracting and quality assurance of healthcare providers are essential. The health facilities indicated that these would require adequate and regular provider payment, investments in infrastructure upgrades and educating the public about insurance benefit plans and service expectations.

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Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria.

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Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria.

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