HEALTH INSURANCE AND ITS IMPACT ON THE ACCESSIBILITY OF HEALTH CARE SERVICES

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

More than sixty developing nations have already begun the process of establishing National Health Insurance (NHI) schemes. The National Health Insurance Fund of Tanzania was formed in 2001, while the National Health Insurance Act of Ghana was promulgated in 2003. Both of these programmes are located in Africa. In southeast Asia, in the year 2000, the Cambodian Health Equity Fund became a pilot programme. In this programme, the majority of the financial resources were supplied by donors in order to compensate for the medical expenses incurred by impoverished individuals. Following the global economic crisis that began in 1997, the government of Indonesia launched a programme that is funded by taxes and is aimed at helping the poor. Under this programme, health care professionals are compensated on a basis that takes into account the patient's overall condition. PhilHealth, the Philippine Health Insurance Business, was established in 1995 with the purpose of establishing universal health care in the Philippines. PhilHealth is a government-owned and -controlled corporation that is exempt from paying taxes.

In low-income nations, health insurance programmes are becoming an increasingly acknowledged component as a strategy for financing the provision of health care (WHO 2016). It has been argued that social health insurance may be able to improve access to health care that is of an acceptable quality. This is because there is a high latent demand from people for health care services that are of a good quality, and there is an extreme under-utilization of health services in several countries. Many authors (such as Gilson 2017) have found fault with alternative methods of financing health care and cost recovery strategies such as user fees. On the other hand, the option of insurance seems to be a promising alternative because it provides the opportunity to pool risks, thereby transferring unpredictable health care costs to fixed premiums (Griffin 2019). On the other hand, there is some evidence to suggest that neither strictly statutory social health insurance nor commercial insurance systems on their own can considerably contribute to increasing coverage rates and, as a result, access to health care. According to Jütting (2018), excessively high unit transaction costs of contracts are typically the cause of both state and market failure. This is especially true in the context of rural and distant environments. Recently, non-profit, mutual, community-based health insurance schemes have emerged, primarily in Sub-Saharan Africa but also in a variety of other countries (Bennett et al. 2018, Jakab & Krishnan 2017). These schemes are based on the principles of support and mutual aid. These plans are distinguished by their commitment to one another's well-being, their sense of community, and their pooling of medical hazards as a group (Atim 2018). These kinds of programmes are run in partnership with health care practitioners in a number of different nations.

Because of the prevalence of fees or health service charges, as well as the high transportation costs encountered by people who have to travel long distances for treatment, the cost of obtaining and accessing proper medical care is relatively higher in developing countries when compared to richer and more developed countries. This is due to the fact that people in developing countries have to travel further to receive treatment, which can include both medical and non-medical expenses.

1.2 Statement of the Problem

Poor families' limited access to inadequate levels of quality healthcare is recognised as a significant problem in both nations with low incomes and those with moderate incomes. These nations have recognised and brought attention to the accessibility gap that currently exists, and now the governments of those nations need to establish effective methods to promote equity. It is estimated that there are 1.3 billion individuals in the globe who do not have access to healthcare that is both inexpensive and sufficient for their needs. There are around 170 million people who have been put in a position where they are compelled to spend more than forty percent of their family income on medical treatment, which puts them in a position where they are at risk of financial ruin. The term "financial catastrophe" refers to the circumstance in which patients are required to pay for their health care, either in the form of a deductible or co-pay, and the amount of money spent on health care is greater than or equal to forty percent of the household's income that is not required for subsistence.

1.3 Objectives of the Study

The main aim of this study is to examine health insurance and its impact on the accessibility of health care services. Other aims of this study are:

i.          To examine the extent health insurance is carried out in health care services in Nigeria.

ii.        To find out the factors that influence health insurance in Nigeria.

iii.      To find out whether health insurance improves the quality of health care services in Nigeria.

iv.      To find out the challenges of health insurance in Nigeria.

1.4 Research Questions

The following research questions will be answered in this study:

i.          To what extent is health insurance carried out in health care services in Nigeria?

ii.        What are the factors that influence health insurance in Nigeria?

iii.      Does health insurance improves the quality of health care services in Nigeria?

iv.      What are the challenges of health insurance in Nigeria?

1.5 Significance of the Study

This study will be beneficial to the medical and insurance sector as the findings of this study will reveal the importance of health insurance, the factors influencing health insurance and its impact on the the quality of health care services in Nigeria.

Finally, this study will serve as an empirical study for further studies and future reference.

1.6 Scope of the Study

This study focuses on health insurance and its impact on the accessibility of health care services. Specifically, this study examines the extent health insurance is carried out in health care services in Nigeria, finds out the factors that influence health insurance in Nigeria, finds out whether health insurance improves the quality of health care services in Nigeria and find out the challenges of health insurance in Nigeria.

1.7 Limitations of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.8 Definition of Terms

Health Insurance: Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals.