AN EVALUATION OF THE EFFECTIVENESS OF HEALTH INSURANCE SCHEME ON HEALTHCARE DELIVERY SYSTEM IN KWARA STATE.

Abstract

health Insurance Scheme (HIS) is a health care scheme established by the Kwara state Government of Nigeria for better healthcare delivery to its populace. The objective of this study was to determine the proportion of Nigerian adults enrolled in the scheme, their satisfaction with the quality and availability of services within the scheme and the factors responsible for the dismal health indices in the country despite the scheme

CHAPTER ONE

INTRODUCTION

• Background of the study

Today we find ourselves at a crossroads where the burden of disease is greater than ever before, especially in low-income countries. Moreover, multi- and bi-lateral donors have increasingly limited resources. The number of individuals living with HIV/AIDS alone (only one of the many health burdens faced today) is over 33 million and the funds necessary to provide treatment for those individuals well-exceed foreign assistance budgets, not to mention local budgets. The centrality of health to State development and poverty reduction is self evident, as improving health status and increasing life expectancy contribute to long term economic development. The legitimacy of any State health system depends on how best it serves the interest of the poorest and most vulnerable people, for which improvements in their health status is geared towards the realization of poverty reduction goals. In the Nigerian context, current reviews show that the country is presently not on course to achieving the health-related Millennium Development Goals (MDGs) by 2020. This poses a major developmental challenge, which will impede and undermine development and economic growth.

We cannot afford anymore to squander valuable resources on programs for which we do not have positive evidence of their impact. Development policymakers across the world are beginning to understand this and impact evaluation research has become a major tool to inform the policy dialogue. Such evaluations lead to crucial decisions to scale-up programs, alter them or replace them with alternative mechanisms. Currently, our knowledge is limited with respect to the impact of health insurance in Africa due in part to the fact that health insurance has historically been limited to the wealthy elite in this part of the world. Findings from other regions are mixed but mostly positive (Giedion and Diaz, 2008). To the best of our knowledge, this impact evaluation is the first rigorous impact study of subsidized low-cost private health insurance and clinic-upgrade programs in Africa, funded by the Health Insurance Fund (HIF) and implemented by the Pharm Access Foundation (Pharm Access). The impact evaluation represents the culmination of a multiyear operational research program on these initiatives led by the Amsterdam Institute for International Development (AIID) and the Amsterdam Institute for Global Health and Development (AIGHD) in several countries. The report evaluates the short-term impact of Hygeia Community Health Care (HCHC) on treatment communities (communities receiving the intervention) in Central Kwara State, Nigeria.

The indispensability of good healthcare system in national development underlies the government’s commitment to providing adequate healthcare services since Nigeria attained political independence in 1960 (Ugbaja, 2003:6). in terms of cost and delivery, the Nigerian healthcare system was adjudged effective and efficient in the periods of the 1960s and up to the late 1970s, by the early 1980s shortage of health facilities including drugs and personnel had set in resulting in rising cost of healthcare services. The situation seemed to favour private sector health institutions which were enjoying relative boost in patronage as the general poor state public healthcare system continued deteriorating. According to Abacha (1985:3), the public hospitals had become (consulting clinics” Given the rapid population growth rate, what the nation needed was a commensurate increasing level of care services. But the decreasing finance of the government oil left the government with no other choice than reducing budgetary allocation to the health sector (Ozuh, 2004:30) prior to the government almost solely financed health services in public health institutions. But by the turn of the 1980s, it had become joint responsibility of the government and the citizens (Ughamadu, 2003:23). In other words both the government and the citizens shared the costs of healthcare services in public health institutions with the greater burden weighing heavily on the government. Subsidization of healthcare services was paramount in healthcare budgetary allocation.

• STATEMENT OF THE PROBLEM

Three years after its inception, the NHIS has not effectively taken off and operated as initially conceived. This is as a result of challenges facing the scheme. First, the scheme is still limited to the public sector and has not been extended to the private sector due to apparent lack of political will and commitment. The scheme suffers from restricted coverage. Second, there is continuous delay in remittance from government establishment to the NHIS council, which also delays remittance to Health Maintenance Organization (HMOS) Providers (HSPS). This makes the scheme to suffer from ineffective financing. Third, the scheme lacks adequate facilities and personnel to cover the nation sufficiently. This arises from the limited number of the Health Maintenance Organization (HMOS) and Health Service Providers (HSPS) registered to operate in the scheme. Besides, most of the HSPs lack adequate medical equipments and dedicated personnel to implement the scheme. Fourth, many of the Health Service Providers (HSPs) are withdrawing from the scheme and some functional ones are refusing to register new clients or public servants.

• OBJECTIVE OF THE STUDY

The main objective of the study is to evaluate the effectiveness of health insurance scheme on the healthcare delivery in Kwara state. But for the purpose of the study; the researcher intends to achieve the following objectives;

1. To evaluate the effectiveness of health insurance scheme in Kwara state
2. To ascertain the constrain to effective health care delivery in the state

• To ascertain if there is any relationship between health insurance scheme and quality of healthcare delivered

1. To ascertain the impact of health insurance scheme on the wellbeing of the populace.

• RESEARCH HYPOTHESES

For the purpose of the study, the following research hypotheses were formulated by the researcher;

H₀: health insurance scheme in Kwara state is not effective

H₁: health insurance scheme in Kwara state is very effective

H₀²: there are no constrain to effective healthcare delivery in the state

H₂: there are constrain to the effective healthcare delivery in the state

• SIGNIFICANT OF THE STUDY

At the completion of the study; it is believed that the findings will be of great importance to 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. 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. 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. 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. 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. 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.

• SCOPE AND LIMITATION OF THE STUDY

The scope of the study covers the evaluation of the effectiveness of health insurance scheme on healthcare delivery. But in the cause of the study the researcher encounters some constrain which limited the scope of the study

(a)Availability of research material: The research material available to the researcher is insufficient thereby limiting the study.

(b)Time: The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.

(c)Finance: The finance available for the research work does not allow for wider coverage as resources are very limited as the researcher has other academic bills to cover.

1.7 DEFINITION OF TERMS

National health insurance scheme

This is a security program under which employers and employees finance health services through contribution (Lambs, 2006:16).

Health Service Providers

This refers to any health institution (hospital, health centers clinics, etc) authorized to provide healthcare service under the NHIS (Ozuh, 2004:30) Health Maintenance organizations (HMOs)

This refers to any authorized body or organization to administer the NHIS by liaising between the NHISC and HSPs (Ozuh, 2004:30).

Healthcare Delivery System

This refers to the provision of health service to. The people (Ughanmadu, 2003:23).

 HMOs

An acronym for Health maintenance organizations (Uduma, 2005:3)

HSPs

An acronym for Health Service Providers (Uduma, 2005:3).

1.8 ORGANIZATION OF THE STUDY

This research work is organized in five chapters, for easy understanding, as follows Chapter one is concern with the introduction, which consist of the (overview, of the study), statement of problem, objectives of the study, research question, significance or the study, research methodology, definition of terms and historical background of the study. Chapter two highlight the theoretical framework on which the study its based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding.  Chapter five gives summary, conclusion, and recommendations made of the study

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