The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria

  • Emily Gustafsson-Wright
  • Gosia Popławska
  • Zlata Tanović
  • Jacques van der Gaag
Research Article


This paper analyzes the quantitative impact of an intervention that provides subsidized low-cost private health insurance together with health facility upgrades in Nigeria. The evaluation, which measures impact on healthcare utilization and spending, is based on a quasi-experimental design and utilizes three population-based household surveys over a 4-year period. After 4 years, the intervention increased healthcare use by 25.2 percentage points in the treatment area overall and by 17.7 percentage points among the insured. Utilization of modern healthcare facilities increased after 4 years by 20.4 percentage points in the treatment area and by 18.4 percentage points among the insured due to the intervention. After 2 years of program implementation, the intervention reduced healthcare spending by 51% compared with baseline, while after 4 years, spending resumed to pre-intervention levels.


Health insurance Financial risk Nigeria Impact evaluation 

JEL Classification

I1 I3 


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Emily Gustafsson-Wright
    • 1
  • Gosia Popławska
    • 2
  • Zlata Tanović
    • 3
    • 4
  • Jacques van der Gaag
    • 1
    • 5
  1. 1.Brookings InstitutionWashingtonUSA
  2. 2.Department of Primary Health Care, Center for Health Service Economics and OrganisationUniversity of OxfordOxfordUK
  3. 3.Vrije University (VU)AmsterdamThe Netherlands
  4. 4.Amsterdam Institute for International DevelopmentAmsterdamThe Netherlands
  5. 5.Department of Economics and BusinessUniversity of AmsterdamAmsterdamThe Netherlands

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