The prominent role of informal medicine vendors despite health insurance
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Date
2020-01-21
Journal Title
Journal ISSN
Volume Title
Publisher
Health Policy and Planning,
Abstract
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 ill nesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsi dized 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 con sulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression
analyses showed that insurance coverage was associated with significantly higher utilization of for mal 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.
Description
Keywords
diaries, healthcare utilization, provider choice, health insurance, Nigeria