Journal of Health and Medical Sciences
Published: 11 June 2021
Health Insurance Uptake and Affordability of Care Among Patients with Hypertension in a Federal Teaching Hospital in Southwestern Nigeria
Tope Michael Ipinnimo, Demilade Olusola Ibirongbe, Motunrayo Temidayo Omowaye, Paul Oladapo Ajayi, Taiwo Samuel Ogunleye
Federal Teaching Hospital (Nigeria), University of Medical Sciences (Nigeria), Afe Babalola Multisystems Hospital (Nigeria), Ekiti State University Teaching Hospital (Nigeria)
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Keywords: Health Insurance Uptake, Affordability of Care, Hypertension, Nigeria
This study aims to assess health insurance uptake and affordability of care among patients with hypertension in a Federal Teaching Hospital in Southwestern Nigeria. This was a cross sectional study involving 138 hypertensive patient selected through systematic random sampling technique from the cardiology clinic of a Federal Teaching Hospital. A semi-structured, interviewer administered questionnaire was used to collect data. Analysis was done using Statistical Package for Social Sciences (SPSS) version 21. A significance level of 5% was used. The mean age (standard deviation) of the patients was 57.4 (12.8) years with median (interquartile range) monthly income of ₦46,500.00 (₦55,000.00) [US$129 (US$152.78)]. The health insurance uptake among them was 26.8%. Out of those who had no health insurance cover, 87.2% of them believed it could make their financial burden less and wish to be registered. Hypertensive patients enrolled under health insurance were significantly less likely to face financial difficulty when paying for drugs (p<0.001) and investigations (p<0.001). Additionally, these patients were significantly less likely to deny or defer project(s) in order to pay for their illness (p=0.004) and to have their source of livelihood being negatively affected by this illness (p=0.002). This study found a low health insurance uptake among hypertensive patients, even though most of the patients who had no health insurance cover were ready to enroll. Additionally, health insurance was identified to promote affordability of care among these patients. It is therefore crucial to put in place measures that will increase health insurance coverage among these patients.
Adegboyega O, Abioye K. (2017) Effects of Health-Care Services and Commodities Cost on the Patients at the Primary Health Facilities in Zaria Metropolis, North Western Nigeria. Niger J Clin Pract., 20:1027-35.
Adewole DA, Dairo MD, Bolarinwa OA. (2016). Awareness and Coverage of the National Health Insurance Scheme among Formal Sector Workers in Ilorin, Nigeria. Afr. J. Biomed. Res., 19:1-10
Ajayi IO, Sowemimo IO, Akpa OM, Ossai NE. (2016). Prevalence of hypertension and associated factors among residents of Ibadan‑North Local Government Area of Nigeria. Nigeria Journal of Cardiology, 13:67-75.
Akande TM, Salaudeen AG, Babatunde OA, Durowade KA, Agbana BE, Olomofe CO et al. (2012). National Health Insurance Scheme and its effect on staff ’s financial burden in a Nigerian Tertiary Health facility. International Journal of Asian Social Science journal, 2(12):2175-2185
Akinlua JT, Meakin R, Umar AM, Freemantle N. (2015) Current Prevalence Pattern of Hypertension in Nigeria: A Systematic Review. PLoS ONE, 10(10):1-18. doi:10.1371/journal. pone.0140021
Alatinga KA, Williams JJ. (2015). Towards Universal Health Coverage: Exploring the Determinants of Household Enrolment into National Health Insurance in the Kassena Nankana District, Ghana. GJDS, 12(1):88-105.
Asfaw A, Gustafsson-Wright E, Van der Gaag J. (2008). Willingness to Pay for Health Insurance: An Analysis of the Potential Market for New Low Cost Health Insurance Products in Namibia. Vol. AIIDRS – 0, Amsterdam Institute for International Development, 1–22.
Bakare OQ, Goodman O, Kuyinu YA, Wright OK, Adeniran A, Odusanya OO, et al. (2016). Antihypertensive use, prescription patterns, and cost of medications in a Teaching Hospital in Lagos, Nigeria. Nigeria Journal of Clinical Practice, 19:668-672. DOI: 10.4103/1119-3077.188709
Bamgboye AE. (2014). Medical Statistics. 2nd ed. Ibadan: Folbam Publisher.
Charles RM, Kioko UM. (2016). Effect of Health Insurance on Demand for Outpatient Medical Care in Rwanda : An Application of the Control Function Approach. Rwanda J Ser B Soc Sci., 3:77-100.
Daramola OE, Adeniran A, Akande TM. (2018). Community Medicine and Patients’ Satisfaction with the Quality of Services accessed under the National Health Insurance Scheme at a Tertiary Health Facility in FCT Abuja, Nigeria. J Community Med Prim Heal Care, 30(2):90-7.
Esan O, Falayi K, Adekunle B, Akimwunmi T, Ajao O, Abubakar Y. (2020). Willingness of in-patient to Uptake the vital contributor Social Health Insurance Program in a Teaching Hospital, Southwest Nigeria. Niger J Med., 29(3):476-85.
Ganiyu KA, Suleiman IA. (2014). Economic Burden of Drug Therapy in Hypertension Management in a Private Teaching Hospital in Nigeria. British Journal of Pharmaceutical Research, 4(1):70-8.
Garba MB, Ejembi CL. (2015). The role of National Health Insurance Scheme on structural development of health facilities in Zaria, Kaduna State, North Western Nigeria. Ann Niger Med., 9(1):9-14.
Hassan MA, Mwaura-Tenambergen W, Eunice MM. (2017). Uptake of health insurance among Muslims in Nairobi county, Kenya. Pan Afr Med J., 28:1-9. doi:10.11604/pamj.2017.28.12.12214
Jeannette N, Court DS. (2014). Medical sciences. 2nd ed. New York, USA. Elsevier Health Sciences, 562.
JNC-8 (2014). New Guidelines. Finally Let the Controversies Begin.
Maina JM, Kithuka P, Tororei S. (2016). Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study. Pan Afr Med J., 23:1-10. doi:10.11604/pamj.2016.23.125.8936
Obalum D, Fiberesima F. (2012). Nigeria National Health Insurance Scheme (NHIS): an overview. Niger Postgrad Med J., 19(3):167-74.
Okoronkwo IL, Ekpemiro JN, Onwujekwe OE, Nwaneri AC, Iheanacho PN. (2016). Socioeconomic inequities and payment coping mechanisms used in the treatment of type 2 diabetes mellitus in Nigeria. Niger J Clin Pract, 19104-9. DOI: 10.4103/1119-3077.173711
Okpani AI, Abimbola S. (2015). Operationalizing universal health coverage in Nigeria through social health insurance. NMJ, 56(5):305-10.
Oyati AI, Orogade AA, Azuh PC, Yakubu PD, Shidali VY. (2016). Impact of National Health Insurance Scheme on blood pressure control in Zaria. Sahel Med J, 19:69-73. Doi: 10.4103/1118-8561.186037
Parks K. (2015). Park’s Preventive & Social Medicine, 23rd ed. Jabalpur, India. M/s Banarsidas Bhanot publishing.
Tesfamichael A, Mirkuzie W, Shimeles O. (2014). Willingness to join and pay for the newly proposed social health insurance among teachers in Wolaita Sodo town, South Ethiopia. Ethiop J Heal Sci., 24(3):195-202.
Trading Economics. (2020). Nigeria National Minimum Wage. Available from: Wages in%Nigeria is, macro models and analysts expectations. [Last accessed 16/11/2020]
Whitehead M. (1992). The concepts and principles of equity and health. Int J Heal Serv., 22:429-45.
World Health Organization. (2014). WHO African region expenditure atlas. Geneva, Switzerland: World Health Organization.
World Health Organization. (2017). World Health Statistics 2017: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva, Switzerland: World Health Organization.