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The prominent role of informal medicine vendors despite health insurance: a weekly diaries study in rural Nigeria.
- Source :
-
Health policy and planning [Health Policy Plan] 2020 Apr 01; Vol. 35 (3), pp. 354-363. - Publication Year :
- 2020
-
Abstract
- In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.<br /> (© The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
- Subjects :
- Developing Countries
Female
Health Personnel classification
Humans
Insurance Coverage statistics & numerical data
Male
Medicine, Traditional statistics & numerical data
Nigeria
Patient Care statistics & numerical data
Pharmacies statistics & numerical data
Rural Population
Health Expenditures statistics & numerical data
Insurance, Health statistics & numerical data
Patient Acceptance of Health Care statistics & numerical data
Patient Preference statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2237
- Volume :
- 35
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Health policy and planning
- Publication Type :
- Academic Journal
- Accession number :
- 31965167
- Full Text :
- https://doi.org/10.1093/heapol/czz172