CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

Insurance is an indisputable instrument for healthcare funding. It has been utilized by most developed nations in its different structures to subsidize healthcare. It is just of late being applied by poorer developing countries to attend to the obvious issue of deficiencies in healthcare availability and funding which has over the years been financed from public funding (Adibe MO, 2011). Healthcare financing alludes to procedures for paying for healthcare expenses. For any economy to grow, it must confer adequate funding to health, keeping in mind the end goal of which is to accomplish anticipated levels of health status and economic improvement (Agbatogun KK, 2010). There are different types of health insurance; they can be broadly divided into private and public insurance based on the source of funding (Sekhri N, 2004). In public the funds are paid by the government from general taxes or hypothecated taxes, this source of funding for health care helps to improve access and promote equity. Available funds in public health insurance are often not enough and need to be supplemented by funds from private insurance. Private health funds are paid directly to the fund managers and consist of non-profit and for-profit plans, and community health insurance schemes. Private coverage, when managed well helps to improve access and equity especially in developing countries, and reduce large out-of-pocket expenses for healthcare (Sekhri N, 2004).  They serve as a useful source of supplementary insurance to provide coverage for health services not covered by the publicly-funded schemes. Poorly planned private health insurance systems have been associated with exacerbating inequalities, the high number of uninsured, and the high cost of out-of-pocket payment.

Social health insurance (SHI) is a compulsory scheme that allows the pooling of funds to finance health services, in addition to other sources such as taxes, private health insurance, community insurance, and others.4 It usually involves defined contribution from the employees, their employers, and government via a payroll deduction system. Overtime the informal sector has been included and contribution here is usually fixed due to difficulties in estimating income. The poor are also not left out as there are special programmes to include them. Under the SHI, the rich pay more than the poor while they receive the same level of care irrespective of their contributions and health status. The funds so realized may be administered as a single or several multiple funds by the public or private sector or a combination of both.

SHI helps to provide extra domestic funds, improves health system quality, reduces health inequality, reduces out-of-pocket spending, provides financial risk protection, and encourages the attainment of universal coverage. Social health insurance is often difficult to extend to the other sectors outside the formal one.4 National health insurance refers to an insurance scheme that covers the entire population and is usually established by national legislation. It is often mandatory for the citizens and the administration of the health care funds vary from country to country.

1. STATEMENT OF THE PROBLEM

The financial burden of health care is high in rural area, Kaduna state. Out-of-pocket expenditure on healthcare constitutes 55.4% of current health expenditure in rural area, Kaduna state. High out-of-pocket healthcare expenditure is a major hurdle in achieving universal health coverage, an explicit target of sustainable development goals. Health insurance (HI) is a mechanism of reducing the out of pocket health care expenditure. Moreover, it diversifies financial risk, raise income levels and can offer large welfare gains. For addressing the financial constraint in health services, the federal Government of Nigeria implemented the national health insurance scheme (NHIS) in 2004. However, the program has been facing many challenges and only small segments of the population are enrolled in this scheme. Prior to this study, rural area, Kaduna state’s government had piloted community-based health insurance program (CBHI) which had also low enrollment (only 3.4%) and there are few published literatures on CBHI in Rural area, Kaduna state. This study analyzes the factors affecting enrollment of national health insurance scheme (NHIS) in rural area of Kaduna state.

1.3 AIM AND OBJECTIVES OF THE STUDY

The study seeks to analyze the factors affecting enrollment of national health insurance scheme (NHIS) in rural area of Kaduna state. The objectives of the study are:

1. To examine the evolution of the national health insurance scheme (NHIS) in rural areas of Kaduna state
2. To determine the national health insurance scheme (NHIS) programmes in rural areas of Kaduna state
3. To examine financial challenges as a factor affecting the enrollment of national health insurance scheme (NHIS) in rural areas of Kaduna state
4. To examine the level of awareness of the enrollment of national health insurance scheme (NHIS) in rural areas of Kaduna state

1.4 RESEARCH QUESTIONS

 The research questions are:

1. How is the evolution of the national health insurance scheme (NHIS) in rural areas of Kaduna state?
2. What are the national health insurance scheme (NHIS) programmes in rural areas of Kaduna state?
3. Are there any financial challenges as a factor affecting the enrollment of national health insurance scheme (NHIS) in rural areas of Kaduna state?
4. What is the level of awareness of the enrollment of national health insurance scheme (NHIS) in rural areas of Kaduna state?

1.5 STATEMENT OF THE HYPOTHESIS

H0: the level of awareness of the enrollment of national health insurance scheme (NHIS) in rural areas of Kaduna state is low

H1: the level of awareness of the enrollment of national health insurance scheme (NHIS) in rural areas of Kaduna state is high

1.6 SIGNIFICANCE OF THE STUDY

The study will be useful to the following;

1.     National Health Insurance Scheme Council (NHISC)

This regulatory body of the NHIS will find this study useful. This is because it will identify all the constraints to effective implementation of the scheme especially as it effects HMOs and HSPs. The regulatory aspect of these challenges will be established in this study so that the NHISC will take remedial measures. The recommendation of this study will be useful in this regard.

2.     Health Maintenance Organization (HMOs)

These organizations will also benefit from; this study. This is because it will not only highlight the challenges facing them under the scheme but will also provide useful information on how they can effectively address these challenges especially those arising from their internal constituencies.

3.     Health Services Providers. (HSPs)

These private health institutions will also benefit from this study. Those already operating under the scheme will be provided with useful information on how to brace up with their challenges while those not yet operating under the scheme will find in this study the need to be integrated into the national healthcare delivery system via the NHIS.

4.     The Government

The government will also see the need to solicit for foreign assistance to effective implementation of the programme as well as to ensure prompt remittance to the NHISC and HMOs from its establishments. The recommendations in this study will also be useful for its policy review in respect of the scheme.

5.     Students

Definitely, the study will add to the little literature on the NHIS and can also serve as reference material to those who will carry out related studies in the future.

6.     The Society

The study will also be useful to the society at large. This is because it will give a full exposition to NHIS and how they can benefit from the scheme.

1.7 SCOPE OF THE STUDY

The study covers on analysis of factors affecting enrollment of national health insurance scheme (NHIS) in rural area of kaduna state with focus on national health insurance scheme (NHIS), Kaduna state

1.8 LIMITATION OF THE STUDY

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work

1.9 DEFINITION OF TERMS

NHIS: national health insurance scheme