The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria
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.
KeywordsHealth insurance Financial risk Nigeria Impact evaluation
JEL ClassificationI1 I3
- Acharya, A., Vellakka, S., Taylor, F., Masset, E., Satija, A., Burke, M., & Ebrahim, S. (2013). The impact of health insurance schemes for the informal sector in low and middle income countries: a systematic review. World Bank Policy Research Working Paper 6324.Google Scholar
- Bernal, N., Miguel, C., & Klein T. (2015). The effects of access to health insurance for informally employed individuals in Peru. Netspar discussion paper series, DP 02/2015-023.Google Scholar
- Brals, D., Aderibigbe, S., Wit, F., van Ophem, J., van der List, M., Osagbemi, G., Hendriks, M., Akande, T., van Hensbroek, M., & Schultsz, C. (2017). The effect of health insurance and health facility-upgrades on hospital deliveries in rural Nigeria: A controlled interrupted time-series study. Health Policy and Planning, 32(7), 990–1001.Google Scholar
- Burger, R., Burger, R. P., & Smith, A. (2015). Does insurance affect health care utilization if the health system is polarized? Evidence from a South African natural experiment. NEUCD conference, Brown University.Google Scholar
- Finkelstein, A., Taubman, S., Wright, B., Bernstein, M., Gruber, J., Newhouse, J. P., Allen, H., Baicker, K., & Oregon Health Study Group (2012). The Oregon Health Insurance Experiment: Evidence from the First Year. The Quarterly Journal of Economics, 127(3), 1057–1106.Google Scholar
- Giedion, U., Alfonso, E., & Diaz, Y. (2007). Measuring the impact of mandatory health insurance on access and utilization: The case of the Colombian Contributory Regime. Washington D.C.: Brookings Institution.Google Scholar
- Giedion, U., Alfonso, E., & Diaz, Y. (2013). The impact of universal coverage schemes in the developing world; A review of the existing evidence. The World Bank, UNICO studies, series 25, January 2013.Google Scholar
- Gustafsson-Wright, E., & Schellekens, O. (2013). Achieving universal health coverage one state at a time: A public–private partnership community-based health insurance model. Brooke Shearer Working Paper. Global Economy and Development. Washington D.C.: Brookings Institution Press.Google Scholar
- Hendriks, M. E., Rosendaal, N. T., Wit, F. W., Bolarinwa, O. A., Kramer, B., Brals, D., et al. (2016). Sustained effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria: A population-based study. International Journal of Cardiology, 202, 477–484.CrossRefPubMedGoogle Scholar
- Hendriks, M. E., Wit, F. W., Akande, T. M., Kramer, B., Osagbemi, G. K., Tanović, Z., et al. (2014). Effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria: A population-based study. JAMA Internal Medicine, 174(4), 555–563.CrossRefPubMedGoogle Scholar
- Khandker, S., Koolwal, G., & Samad, H. (2010). Handbook on impact evaluation quantitative methods and practices. Washington D.C: The World Bank.Google Scholar
- Kramer, B. (2017). From awareness to adverse selection: cardiovascular disease risk and health insurance decisions. SSRN Working paper. https://doi.org/10.2139/ssrn.2636210.
- Langedijk-Wilms, A. (2014). Personal communication with PharmAccess Group.Google Scholar
- Lu, C., Chin, B., Lewendowski, J. L., Basinga, P. Hirschorn, L., & Binahgwaho, A. (2012). Towards universal health coverage: An evaluation of of Rwanda Mutuelles in its first eight years. PLOS ONE, 7(6), e39282.Google Scholar
- Manning, W.., Newhouse, J., Duan, N., Keeler, E., & Leibowitz, A. (1987). Health insurance and the demand for medical care: Evidence from a randomized experiment. The American Economic Review, 77(3), 251–277.Google Scholar
- National Health Insurance Scheme (NHIS). Retrieved on 14 June 2013. http://nhis.gov.ng/index.php?option=com_content&view=article&id=47:welcome-note-from-executive-secretary&catid=34:home.
- Palacios, R., Das, J., & Sun, C. (2011). India’s Health Scheme for the Poor. New Delhi, India: Center for Policy Research.Google Scholar
- Saleh, K. (2013). The health sector in Ghana: A comprehensive assessment. Washington DC: Directions in Development, Human Development World Bank.Google Scholar
- The World Bank Databank. (2010). Maternal mortality ratio (modeled estimate, per 100,000 live births). Retrieved on 17 June 2013. http://data.worldbank.org/indicator/SH.STA.MMRT.
- The World Bank Databank. (2013). Health expenditure per capita (current US$) and Health expenditure, public (% of total health expenditure). Retrieved on 6 June 2015. http://data.worldbank.org/indicator/SH.XPD.PCAP/countries/NG?display=graph.
- The World Bank Databank: Health Nutrition and Population Statistics. (2010). Adults (age 15+) and children (0–14 years) with HIV. Retrieved on 17 June 2013. http://databank.worldbank.org/data/views/reports/tableview.aspx.
- Wagstaff, A., Lindelow, M., Jun, G., Ling, X., & Juncheng, Q. (2009). Extending health insurance to the rural population: an impact evaluation of China’s New Cooperative Medical Scheme. Journal of Health Economics, 28(1), 1–19.Google Scholar
- Wagstaff, A., & Moreno-Serra, R. (2007). Europe and Central Asia’s great post-communist social health insurance experiment: Impacts on health sector and labor market outcomes. Washington, D.C.: World Bank Policy Research Working Paper 4371.Google Scholar
- Wagstaff, A., & Pradhan, M. (2005). Health insurance impact on health and nonmedical consumption in a developing country. Washington, D.C.: World Bank Policy Research Working Paper No. 3563.Google Scholar
- World Health Organization. (2011). The Abuja declaration: Ten years on. Geneva: World Health Organization.Google Scholar
- World Health Organization Global Health Observatory Data Repository. (2012). General government expenditure on health as a percentage of total government expenditure. Retrieved on 4 June 2015. http://apps.who.int/gho/data/view.main.HEALTHEXPRATIONGA?lang=en.
- Yilma, Z., Mebratie, A., Sparrow, R., Dekker, M., Alemu, G., & Bedi, A. (2015). Impact of Ethiopia’s Community Based Health Insurance on Household Economic Welfare. The World Bank Economic Review, 29(Supple 1), 1–10.Google Scholar
- Yip, W., & Hsiao, W. (2008). The impact of rural mutual health care on access to care: Evaluation of a social experiment in rural China. Harvard School of Public Health Working Paper.Google Scholar