Abstract:
The Health Insurance Scheme (HIS), a means of financing medical care among employees
globally, is designed to subsidise medical costs. In Nigeria, HIS is inadequately implemented
and this affects access to healthcare among employees, particularly in the private sector.
Existing studies have mainly focused on biomedical aspects of HIS in the public sector with
scant attention given to the social factors associated with its utilisation among employees of
private organisations, including Enugu State, where the scheme has officially been adopted by
private sector organisations. This study, therefore, examined the extent to which HIS is utilised;
influence of its adoption on health-seeking behaviour; treatment pathways of enrollees; gender
differentials in its utilisation; and the challenges reported by private sector employers that have
enlisted in the scheme in Enugu State.
The Structural Functionalist Theory and Health Belief Model served as framework, while the
cross-sectional survey design was employed. The purposive sampling technique was used to
select one organisation from each of the manufacturing and service industries that have adopted
HIS. A sample of 457 respondents were drawn using Yamane’s formula. Simple random
sampling was used to proportionately administer semi-structured questionnaire to employees in
manufacturing (369) and service (88) industries. Twenty-four in-depth interviews were
conducted with employees in manufacturing (14) and service (10) industries. Sixteen key
informant interviews were conducted with management staff of manufacturing (5) and service
(3) industries. Four healthcare providers from National Health Insurance Agency (NHIA)
accredited hospitals, two managers of health maintenance organisations, and two NHIA
executive officers. The quantitative data were analysed using descriptive statistics, Logistic
regression and T-test at p≤0.05, while the qualitative data were content-analysed.
The respondents’ age was 38±2.4 years; 77.4% had tertiary education and 70.8% were married.
Forty-six percent partially utilised and 32.0% adequately utilised HIS. The extent to which HIS
was adequately utilised was significantly associated with respondents’ aged ≥50 years
(OR=4.87), tertiary education (OR=3.53) and those who were married (OR=2.57). Influence of
HIS on health-seeking behaviour was significantly associated with senior staff (OR=1.57) and
100, 000 (OR=4.04) as monthly income. The treatment pathways for
employees started with visit to HIS hospitals (61.2%), home therapy (23.2%), visit to hospitals
without HIS (12.5%), faith/religious centres (2.9%) and traditional medical centre (0.2%).
Some of those who did not visit HIS accredited hospitals at the onset of their ill-health resorted
to visiting HIS accredited hospitals when their condition deteriorated. Female employees
(52.6%) were more likely to seek healthcare through HIS than their male counterparts (47.4%)
after enrolling in HIS plan. Private sector employers’ challenges in the adoption of HIS included
payment of premium, abuse of the scheme by some employees, complex bureaucratic structure
of the scheme and employees' inability to access certain treatments due to their organisations’
chosen HIS plan.
Socio-organisational and individual factors influenced the adoption of health insurance scheme
and the health seeking-behaviour of private sector employees in Enugu State, Nigeria. Health
maintenance officials, Healthcare providers and other stakeholders should therefore increase
awareness about the benefits of utilising health insurance scheme by private sector employees
in order to reduce out-of-pocket health expenditure.
