HEALTH INSURANCE: 8 in 10 Adult Nigerians Have No Cover – New Poll Reveals

Abuja, Nigeria. 9th November 2021.  A new public opinion poll conducted by NOIPolls has revealed that almost 8 in 10 Nigerians (77 percent) do not have health insurance cover. In addition, 5 percent revealed that their healthcare services are paid for by family and friends. Further analysis by occupation revealed that artisans (93 percent), farmers and agricultural workers (91 percent), religious leaders (89 percent), self-employed traders (88 percent), businessmen and women (88 percent), Youth corps members (86 percent) and unemployed (84 percent) are among households and individuals that are paying out-of-pocket and incurring catastrophic health expenditure to access healthcare services in the country.

This simply suggests that coverage of health insurance has remained abysmal despite the National Health Insurance Scheme (NHIS) which was established in 2006 to achieve Universal Health Coverage (UHC) in Nigeria with financial risk protection mechanisms. Analysis by geographical location shows that health insurance coverage rates are highest in the North-West zone (24 percent) whereas it is lowest in the South-East zone (14 percent).

More findings revealed that 57 percent of adult Nigerians who pay out-of-pocket to access healthcare are willing to pay money monthly or yearly to get enrolled into the health insurance scheme. This further provides evidence that access is a major issue concerning health insurance across the country.

Therefore, there is a need for a determined and deliberate approach towards mass enrolment of Nigerians by relevant stakeholders as well as intensive sensitization as 47 percent disclosed that they are not aware of the National Health Insurance Scheme. This will go a long way in reducing the incidence of out-of-pocket payments and incurring catastrophic healthcare expenditures. These are some of the key findings from the poll conducted in the week commencing August 30th, 2021.

Survey Background

Universal health coverage is a global drive aimed towards ensuring that all people in the world have access to quality healthcare delivery they need, when and where they need them without undergoing financial hardship. However, it is saddening to note that a large percentage of the world population do not have access to affordable care due to a lack of health insurance coverage.

According to the World Health Organization, about 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. The WHO data further states that 930 million people spend at least 10 percent of their household income on health care and to further buttress the lack of access to health care around the world, the statistics show that half of the world’s population do not have access to the healthcare they need.[1] There is indeed a  crisis of healthcare deliverable at an affordable cost to a larger percentage of the world populace.

In a bid to tackle access to healthcare in Nigeria at an affordable rate through health insurance, the Federal Government established the National Health Insurance Scheme (NHIS) under Act 35 of the 1999 constitution as amended to provide quality health care to all Nigerians at an inexpensive cost. They are to organise a payment structure where all contributors contribute to a common pool and all health expenses are paid from it thereof. By its statutory functions, it is expected to regulate the activities of the private arm of the health insurance policy of the government.[2]

How has the National Health Insurance scheme fared since its establishment to date? How has it bridged the gap of the absence of viable health insurance among the Nigerians? It remains to be seen if the average Nigerian has benefited in the area of quality healthcare insurance in the country since the establishment of the scheme. Also, what does the future hold for the health insurance policy in the country vis-à-vis the tackling of the growing gulf in the provision of affordable health care policy in the country? Against the background, NOIPolls conducted a public opinion poll to feel the pulse of Nigerians regarding health insurance in the country.

Survey Findings

The first question sought to find out the self-assessment of the health status of adult Nigerians and the findings show that 88 percent rated themselves healthy whereas 12 percent rated themselves as not healthy. Analysis by geographical locations indicates that the South-East and South-South zones (93 percent each) rated themselves better than other zones with regards to the self-assessment of their health status. In addition, more analysis by age group shows that young Nigerians (18 – 35) rated their health status better than the middle-aged (36 – 60) and the elderly (61+).

Trend analysis shows that the self-assessment of the health status of adult Nigerians is generally better in 2021 than in 2019 as indicated by a 1 percent increase in the chart below.

The second question sought to know what Nigerians do when they fall ill. The result revealed that the majority of adult Nigerians (87 percent) disclosed that they visit the hospital when ill and Nigerians residing in the North-West (97 percent) and North-East (96 percent) zones accounted for the larger proportion of Nigerians in this category.

On the contrary, 13 percent claimed that they do not visit the hospital when ill and respondents from the South-East (28 percent) and South-South (25 percent) zones had more people who made this assertion.

Trend analysis shows that there is no increase in the percentage of respondents who go to hospital between 2019 and 2021.

The respondents who claimed that they do not go to hospital were further probed and findings revealed that 44 percent visit a pharmacy when ill and this is predominant with Nigerians residing in the South-South zone (57 percent). Also, 39 stated that they visit a chemist when they are ill and Nigerians living in the North-East and South-South zones (57 percent each) had more respondents who made this assertion. Interestingly, 28 percent said that they self-medicate, while 9 percent mentioned that go to a traditional doctor when ill and this is mainly associated with respondents residing in the North-West (63 percent) and North-Central zones respectively. 

Furthermore, respondents who stated that they go to the hospital when ill were further probed and the poll result revealed a high utilization of public hospitals across the country as 71 percent of disclose that they visit the public hospital when ill. Analysis by gender revealed that there are more females (74 percent) than males (67 percent) who visit public facilities when ill. In addition, respondents aged 61 and above (83 percent) visit public facilities more than any other age-group as indicated in the chart below.

Significant findings from the poll show that a very high proportion of adult Nigerians (77 percent) pay out-of-pocket for healthcare services. A further 5 percent revealed that their healthcare services are paid for by family and friends.

On the other hand, only 18 percent of Adult Nigerians indicated that they have health insurance cover. This implies that health insurance has remained very low despite the National Health Insurance Scheme (NHIS) which was established in 2006 to achieve Universal Health Coverage (UHC) in Nigeria with financial risk protection mechanisms.

Analysis by geographical location shows that health insurance coverage rates are highest in the North-West zone (24 percent) whereas it is lowest in the South-East zone(14 percent).

Further analysis by occupation revealed that artisans (93 percent), farmers and agricultural workers (91 percent), religious leaders (89 percent), self-employed traders (88 percent), businessmen and women (88 percent), Youth corps members (86 percent) and unemployed (84 percent) are among households and individuals that are paying out-of-pocket and incurring catastrophic health expenditure to access healthcare services in the country.

Further analysis shows that government workers/ civil servants (51 percent), and professionals, mainly workers in private organizations, (30 percent) top the list of individuals who access health insurance in the country.  

Trend analysis shows a 3 percent increase in the proportion of people with health insurance cover when the current result is compared to the result obtained in 2019 as indicated in the chart below.

Respondents who stated that they access health insurance were further probed and findings revealed that the majority of the respondents (74 percent) access healthcare services through the NHIS. This assertion is prevalent with respondents who reside in the North-East zone (92 percent). Also, disaggregation by age group, shows that those aged 61+ and above (80 percent) use NHIS more than any other age group in the country.

With regards to private health insurance, 26 percent disclosed that they access care through private health insurance organizations and respondents residing in the South-South zone had more Nigerians (48 percent) who stated this.

Consequently, all respondents, asides those who indicated that they use NHIS, were asked if they are aware of the National Health insurance scheme (NHIS) and slightly above average (53 percent) of respondents acknowledged that they are aware of the scheme whereas 47 percent disclosed that they are not aware of NHIS. While respondents residing in the North-West zone (61 percent) showed more awareness, those in the South-South zone claimed not to be aware of the scheme.

Additionally, the poll ascertained the willingness of Nigerians who currently pay out-of-pocket to pay money monthly or yearly to access healthcare services whenever they need it. In response to this, 57 percent of the respondents disclosed that they are willing to pay money monthly or yearly to get enrolled into the health insurance scheme. With regards to  age-group, a majority of respondents aged 18 – 35 years indicated that they are willing.

On the other hand, 43 percent of the respondents stated otherwise and respondents residing in the south-East and South-South zones (63 percent each) had more respondents who made this assertion.

Respondents who expressed willingness to enroll for the scheme were further asked if they know how to go about getting enrolled in the health  insurance scheme. The result revealed that 11 percent stated that they know how to go about getting a health insurance cover whereas 89 percent claimed that they do not know how to go about it.

Conclusion

The poll found that 77 percent of respondents make out-of-pocket for healthcare. Too many Nigerians suffer financial hardships when they make catastrophic health expenditures. Evidence shows that some healthcare expenditures can push people further into poverty. A way to reverse this high out-of-pocket payment is for the government at all levels in Nigeria to accelerate the push for Universal Health Coverage. A quick way of achieving this is to increase health insurance coverage. It is gratifying that at least 7 Nigerian States have signed health insurance laws to help in achieving equitable and sustainable health financing mechanisms.[3] Functional State health insurance schemes will help increase the pool of individuals with health insurance thereby driving down premiums.

Finally, the poll shows an urgent need for interventions in the Nigerian health system to reduce the incidence of out-of-pocket health expenditure. The proportion of the population covered by financial risk protection in healthcare utilization is too low at 18 percent, compared to a benchmark of 90 percent for an efficient health system, and this reflects how far the country lags in the race toward universal health care coverage. High out-of-pocket rates are associated with low uptake of preventive health services, weak management of health care and raise the possibility that patients are too sick before they seek healthcare. The poor segment of the population would likely not seek healthcare because of the inability to pay, and this weakens the performance of the health system in terms of its ability to protect the weak.

Survey Methods

The opinion poll was conducted in the week commencing August 30th, 2021. It involved telephone interviews of a proportionate nationwide sample of 1,000 randomly selected phone-owning Nigerians aged 18 years and above, representing the six geopolitical regions and 36 states and the FCT of the country. Interviews were conducted in 5 languages – Igbo, Hausa, Yoruba, Pidgin English, and English. Although we can say with 95% confidence that the results obtained were statistically precise – within a margin of error of plus or minus 4.65%; we recognize that the exclusive use of telephone polling has its limitation of excluding non-phone-owning Nigerians. Nonetheless, with the country’s teledensity put over 100 percent by the Nigerian Communications Commission (NCC), we consider our telephone polling approach appropriate. Also, given the rigorous scientific process of randomization and stratification applied, we can confidently stand by the validity of our methodology and approach.

NOIPolls Limited, No1 for country-specific polling services in West Africa. We conduct periodic opinion polls and studies on various socio-economic and political issues in Nigeria. More information is available at www.noi-polls.com.

Disclaimer

This press release has been produced by NOIPolls Limited to provide information on all issues which form the subject matter of the document. Kindly note that while we are willing to share results from our polls with the public, we only request that NOIPolls be acknowledged as authors whenever and wherever our poll results are used, cited, or published. NOIPolls hereby certifies that all the views expressed in this document accurately reflect the views of respondents surveyed for the poll, and background information is based on information from various sources that it believes are reliable; however, no representation is made that it is accurate or complete. Whilst reasonable care has been taken in preparing this document, no responsibility or liability is accepted for errors or fact, or any views expressed herein by NOIPolls for actions taken because of information provided in this report. Any ratings, forecasts, estimates, opinions, or views herein constitute a judgment as at the date of this document. If the date of this document is not current, the views and content may not reflect NOIPolls’ current findings and/or thinking.

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[1] https://www.who.int/health-topics/universal-health-coverage#tab=tab_1

[2] https://www.nhis.gov.ng/about-us/

[3] https://www.vanguardngr.com/2016/07/7-states-pass-health-insurance-law-nhis/