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Determinants of health insurance adoption among residents of Lagos, Nigeria: A cross-sectional survey

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Abstract

Introduction

This study assessed health insurance uptake, and payment preferences for health insurance enrollment, and identified barriers and facilitators of the utilization of health insurance amongst residents in Lagos State.

Methodology

The study employed a cross-sectional survey design to gather data from 2,490 residents across four local government areas in Lagos State, Nigeria, between December 2022 and March 2023. Participants were selected through a multistage sampling technique, and data were collected using pre-tested, semi-structured questionnaires. The analysis comprised univariate, bivariate, and binary logistic regression analyses, performed using the STATA 15.0 software package. The level of statistical significance was set at P < 0.05, and 95% confidence intervals were calculated for the adjusted odds ratios.

Results

Awareness of health insurance was generally average among respondents (54.4%) and extremely few respondents (10.9%) had ever been enrolled in one form of health insurance or the other. The private health insurance schemes were the most frequently patronized scheme (58.5%) while the Lagos State-owned scheme was patronized by less than one-fifth (15.9%) of respondents. The need to prevent a catastrophic health event (56.3%) and compulsion at the workplace (13.1%) were the main facilitators of health insurance uptake while financial constraints (10%) and a general lack of belief in the concept of health insurance (6%) were major barriers that prevented enrollment. Age, employment status, level of education, income, occupation, and rate of health morbidity were all predictors of health insurance adoption in this study (P < 0.05).

Conclusion

Heightened awareness campaigns are necessary from both government and private entities in the health insurance sector. Additionally, the government should enforce mandatory enrollment in health insurance schemes in order to boost insurance coverage across the population.

Keywords: health insurance; National Health Insurance Scheme; LASHMA; UHC; Lagos; Nigeria

1 Introduction

The World Health Organization (WHO) report of 2015 revealed that over 90 million individuals faced financial difficulties due to paying for healthcare expenses out of their pockets [1]. In response, the WHO introduced Universal Health Coverage (UHC) to promote increased access to quality healthcare and combat the financial implications of out-of-pocket health payments [2]. However, achieving UHC without an effective health financing system may prove impossible. UHC aims to provide access to quality healthcare for everyone, including the poor. Health insurance acts as a mechanism to protect individuals from high healthcare costs and improve access to quality care, making it an essential tool in achieving UHC.

Innovations and technology in healthcare have caused an increase in healthcare costs, and this has been accompanied by limited access to the highest quality of care in underserved populations [3]. Globally, out-of-pocket expenditure on health is as low as 15% or below across major European countries [4] while it ranges from between 50 and 70% across many low-middle-income countries [5]. In Nigeria, healthcare is funded through different sources, however, current estimates suggest that over 70% of Nigerians still depend on out-of-pocket payments, making it the major source of healthcare financing in the country [6]. According to the World Bank, out-of-pocket spending on health care is directly linked to an increase in the number of people who fall into extreme poverty [7]. With over 90 million Nigerians already living in poverty, [8] it is essential to provide financial protection to prevent more individuals from being pushed into extreme poverty due to healthcare costs.

The Nigerian government established the National Health Insurance Scheme (NHIS) in response to the increased number of out-of-pocket payments and the call for a movement towards UHC [9]. Although NHIS started its operation in 2005, less than 5% of the Nigerian population had been enrolled in this program with higher coverage amongst people in the Federal sector, leaving the greater part of the population uninsured [10,11]. Another source of health financing is private health insurance (PHI) which covers less than 1% of the Nigerian population [12]. In addition to the NHIS and PHI schemes, state health insurance schemes may also provide opportunities for health financing for citizens [9,13].

The NHIS launched fully under the Federal Sector Social Health Insurance Programme in 2005 and covered only the formal sector-which is about 4% of the Nigerian population. Under this scheme, state governments are also permitted to establish state-based health Insurance schemes. In 2007, Lagos State, often described as the commercial capital of Nigeria launched Community Based Health Insurance schemes to provide social health protection coverage for the poor and underserved communities while the Lagos State Health Management Agency (LASHMA) was established to provide quality healthcare and reduce out-of-pocket spending. Subsequently, LASHMA launched the Lagos State Health Insurance Scheme in 2019. However, there is a lack of literature assessing the uptake of health insurance in the state. Challenges to successful implementation include poor services at public facilities, barriers to female education, fragmented public schemes, lack of political will, and low uptake of available health insurance, among others.

Some studies have tried to explore some identified barriers and drivers that encourage the uptake of health insurance in various parts of the world. A systematic review conducted in low- and middle-income countries revealed that culture, amount of premium and timing of premium collection, convenient paying time for premium, trust, and satisfaction in insurers were some factors that influenced the uptake of health insurance [14,15].

Furthermore, lack of enrollment information, proximity to enrollment centers, carelessness in decision-making despite enough income and negative views shaped by poor experiences of friends and families who have used insurance schemes, and poor quality of services and care received were implicated as barriers to the uptake of health insurance among informal care workers in Tanzania [19].

A meta-analysis conducted to explore factors that influence the uptake of health insurance schemes identified other factors such as household income, age of household head, household head being married, education status, female-headed households, household size, and history of chronic illness in the family as those identified with voluntary uptake of health insurance [16].

Surveillance of health insurance uptake is important for planning outreach activities to increase enrollment and access to health care financing within the population. Ultimately, these measures can reduce the burden of disease, and poverty linked with the high cost of health care, especially for the underserved. Findings from this study may be useful to policymakers in the identification of sociodemographic groups within the populations without health insurance coverage in the state and for measures aimed at increasing the uptake of health insurance within the state. This study aimed to assess the health insurance uptake and payment preferences for health insurance enrollment, and identified barriers and facilitators of the utilization of health insurance amongst residents in Lagos State.

2 Methodology

2.1 Description of study area, study design and population

Lagos is one of the states in the South-west region. A former capital city of Nigeria is the economic capital of Nigeria with over 20 million inhabitants. Lagos is divided into 20 local government areas (LGAs) and 57 LCDAs, consisting of 16 urban and 4 rural LGAs. This was a descriptive community-based cross-sectional study to assess the uptake of health insurance and its determinants among residents of Lagos State.

The study participants include consenting individuals aged 18 years and above residing in Lagos at the time of the study.

2.2 Sample size calculation

Using a Population size (for finite population correction factor or fpc) (N): >1,000,000, the sample size was determined using the formula: n = [DEFF*Np(1 − p)]/[(d2/Z21 − α/2*(N − 1) + p*(1 − p)]. The hypothesized % frequency of outcome factor in the population (p) was 30% based on a prior study [4] with Z a confidence interval of 95% (1.96). A minimum sample size of 430 was calculated and adjusted to 645 assuming a design effect of 1.5, but increased to 750 per LGA to further improve the power of this study. Therefore, the study used an estimated sample size of 3,000 for the selected 4 LGAs.

2.3 Sampling method

A multi-stage sampling technique was used to select participants for the study [17]. Simple random technique was used to select four LGAs from the sampling frame of 20 LGAs in the state by balloting in the first stage, 3 out of the 16 urban LGAs and 1 out of the 4 rural LGAs. Agege, Mushin, Lagos Island, and Epe (rural) LGAs were all selected. In the second stage, one ward was selected randomly from each LGA. A sampling frame of all the streets in the selected wards was created, and a minimum of ten streets were selected using a table of random numbers. For the third stage, houses were selected on each street by systematic random sampling. The index house was determined by picking an integer between one and the sample interval by balloting. Thereafter, subsequent houses were determined by systematic random sampling based on the calculated sample interval. In the fourth stage of selection, one household was selected by balloting, and any consenting adult was approached for selection. In situations where more than one consenting adult expressed an interest, only one of them was chosen by balloting. All consenting adults were enrolled from each of the houses.

2.4 Survey instruments & data collection techniques

A pre-tested, interviewer-administered questionnaire with both open and closed-ended questions developed from a previously validated measure [18] to determine the uptake of health insurance was used. Face validation of the instrument was also done by all the investigators. The questionnaire was divided into three sections: the first section collected information on the socio-demographic and economic characteristics of the respondents, the second section focused on the household’s general and healthcare expenditure, and the third section gathered information on the respondents’ health insurance enrollment. Pre-testing of the tool was conducted among 20 randomly selected residents in another urban LGA in Lagos State for relevance, acceptability, and reliability. The final data collection tool was further corrected accordingly. The research assistants were adequately trained on the instruments to prevent information bias.

  1. Informed consent: Prior to participation, all subjects provided written informed consent. Participants were guaranteed confidentiality of their personal data and informed of their right to discontinue involvement in the study at any stage without consequence.

  2. Ethical considerations: Ethical approval was obtained from the Health Research Ethics Committee of the Lagos State University Teaching Hospital. (LREC 06/10/1866).

2.5 Study outcome measures

Information on the age (in years), sex, marital status, the highest level of education, income level per month (Naira), and health insurance uptake among respondents were the key measures in this study. Health insurance uptake was assessed by asking respondents to select their health insurance plan among the options: No Insurance, NHIS, Community-based Insurance, Private Insurance (PI), and the Lagos State Health Insurance Scheme. At the time when the data were collected, the sum of N780 was equivalent to $1.

2.6 Statistical analysis

Sociodemographic information and health insurance uptake were presented using descriptive statistics. Associations between the explanatory variables such as age, gender, occupation, income, and so on and the outcome variable (Health Insurance Uptake) were investigated at the 5% level of significance. Logistic regression models that accounted for the survey design were fitted to identify the independent predictors of Health Insurance Uptake. All significant variables in the bivariate analysis were fitted into the logistic regression model and presented as unadjusted odd ratios. P-values < 0.05 were considered significant, and statistical analysis was done using STATA 15.0 software (StataCorp LLC Lakeway Drive, College Station, Texas).

3 Results

The urban LGAs had the highest number of respondents (77.2%) while rural LGA had the least number with 22.8% of respondents. The mean age of respondents was 36.4 ± 12.9 years with respondents below 40 years constituting the majority (66.7%) of respondents. More than half (56.5%) of the respondents were married and about three-quarters (68.6%) had completed at least a secondary education. Less than a third of respondents (17.7%) were unemployed while about a quarter (20.6%) were non-skilled laborers (Table 1).

Table 1

Socio-demographic and household profile of respondents

Socio-demographic profile of respondents Frequency (N = 2,490) Percentage (%)
Place of residence
Urban 1,922 77.2
Rural 568 22.8
Age of respondents ( n = 2,489)
<30 859 34.5
30–40 802 32.2
41–50 477 19.2
51–60 222 8.9
>60 129 5.2
NR 1 0.0
Mean ± SD 36.35 ± 12.85
Median (Min-Max) 34.00(9.00–85.00)
Gender
Male 1,260 50.6
Female 1,230 49.4
Marital status ( n = 2,489)
Single 926 37.2
Married 1,406 56.5
Widow/Widower 121 4.9
Others 36 1.4
NR 1
Religion
Christian 1,435 57.6
Islam 1,039 41.7
Others 16 0.6
Education level completed
Primary 233 9.4
Secondary 1,475 59.2
Tertiary 635 25.5
Postgraduate 77 3.1
No formal education 70 2.8
Employment status
Self-employed 1,290 51.8
Paid employment 758 30.4
Unemployed 440 17.7
NR 2 0.1
Occupation
Professionals, senior administrators, owners of large-scale industries 77 3.2
Non-academic professionals e.g. nurses, teachers, secretaries 311 12.5
Skilled workers (manual and non-manual) e.g. clerks, typists, artisans 731 29.3
Semi-skilled and small-scale traders 413 16.6
Unskilled workers e.g. petty traders, farmers 514 20.6
NR 444 17.8
Estimated monthly family income (₦) ( n = 2,483)
<30,000 458 18.4
30,000–50,000 852 34.3
50,001–100,000 849 34.2
>100,000 324 13.0
NR 7 0.1
Mean ± SD 72750.11 ± 109518.35
Median (Min-Max) 50000.00(0.00–3000000.00)
Number of people in the household ( n = 2,489)
<4 1,126 45.2
4–6 1,267 50.9
>6 96 3.9
NR 1 0.0
Mean ± SD 6.39 ± 121.19
Median (Min-Max) 4.00(0.00–6000.00)
Level of education of household head
Primary 48 1.9
Secondary 449 18.1
Tertiary 262 10.5
Postgraduate 65 2.6
Don’t know 1,666 66.9

NR: Non Response.

About a fifth of the respondents (18.4%) were earning below the national minimum wage of N30,000 while the average number of household occupants was about 6. About a quarter of the respondents (20%) admitted that their head of house had at least secondary education. In contrast, about two-thirds (66.9%) were unaware of the educational status of their household head (Table 1).

3.1 Awareness, uptake and factors influencing uptake of health insurance

Almost half of the respondents (45.6%) had not heard of health insurance ever and only two-thirds (66.3%) of those who had ever heard about the terminology were aware of one or more health insurance schemes available in the country. About 10.9% of respondents had ever been enrolled in one form of health insurance or the other. The PHI schemes (58.5%) were the most frequently patronized scheme while the Lagos State-owned scheme (ILERA EKO) was patronized by less than one-fifth (15.9%) of respondents who had ever enrolled in any scheme. (Table 5). Income of respondents, occupational status, employment status, level of education, and knowing someone who had enjoyed health insurance in the past were some of the factors that showed a statistically significant association with uptake of health insurance among respondents (P < 0.05) (Table 3). Those who had a higher education enrolled in health insurance much more than those who had no formal education with those who had a tertiary education (44.2%) and postgraduate education (33.3%) ever enrolling in health insurance than others (P < 0.05). Respondents who were highly skilled workers (56.6%) enrolled in health insurance more than other occupational classes (P < 0.05). Those who were self-employed (17.3%) were the least enrolled in health insurance when compared to those in paid employment (43.0%) (P < 0.05). Those who had a monthly income of more than 100,000 naira (62.1%) enrolled in health insurance much more than those who earned lower incomes (P < 0.05) while those who knew someone previously enrolled in health insurance (69.7%) also had ever enrolled in health insurance much more than those who didn’t know anyone previously insured (19.7%) (P < 0.05). Being employed and having a higher level of education of the respondents showed the highest odds (1.82, 1.41) respectively of respondents’ uptake of health insurance (P < 0.05) (Table 4).

Table 2

Payment preferences and enrollment scenarios

Payment preferences and enrollment Frequency (N = 2,487) Percentage (%)
Willingness to continue paying premium if enrolled on a self-paid health insurance plan for 1 year and enjoyed the service
Yes 1,429 57.5
No 1,057 42.5
NR 1 0.0
Willingness to continue paying premium if enrolled on a free health insurance plan for 1 year and enjoyed the coverage
Yes 1,447 58.2
No 1,037 41.7
NR 3 0.1
Preferred amount to pay yearly
Mean ± SD 15524.37 ± 19079.67
Median (Min–Max) 10000.00(0.00–360000.00)
Frequency of payment ( n = 1,493)
Monthly 278 18.6
Quarterly 153 10.2
Yearly 1,062 71.1
Willingness to continue paying for premium if enrolled in a health insurance plan for 1 year and no illness recorded within the period
Yes 1,050 42.2
No 1,435 57.7
NR 2 0.1
Know anyone who is on a health insurance plan and enjoyed it
Yes 207 8.3
No 2,277 91.6
NR 3 0.1
Action to take if a neighbor/co-worker needs medical attention
Give them money to take care of themselves 1,061 42.7
Encourage them to subscribe to a health insurance scheme 819 32.9
Do nothing 512 20.6
Others 92 3.7
NR 3 0.1
Willingness to encourage family & friends to enroll in a health insurance scheme
Yes 1,679 67.5
No 808 32.5

NR: Non response.

Table 3

Determinants of uptake of health insurance among respondents

Variable Ever enrolled in any of the health insurance schemes Statistic P-value
Yes No Total
Level of education
Primary 10(20.4) 39(79.6) 49(100.0) X 2 = 75.1 <0.0001
Secondary 72(17.8) 333(82.2) 405(100.0)
Tertiary 176(44.2) 222(55.8) 398(100.0)
Postgraduate 12(33.3) 24(66.7) 36(100.0)
No formal education 0(0.0) 13(100.0) 13(100.0)
Employment status
Self-employed 78(17.3) 372(82.7) 450(100.0) X 2 = 68.9 <0.0001
Paid employment 156(43.0) 207(57.0) 363(100.0)
Unemployed 36(41.4) 51(58.6) 87(100.0)
Occupational class
Highly skilled professionals 30(56.6) 23(43.4) 53(100.0) X 2 = 123.9 <0.0001
Skilled professionals 119(51.5) 112(48.5) 231(100.0)
Skilled workers 43(16.8) 213(83.2) 256(100.0)
Semi-skilled workers 27(21.1) 101(78.9) 128(100.0)
Unskilled workers 15(10.3) 130(89.7) 145(100.0)
Monthly income (₦)
<30,000 13(14.6) 76(85.4) 89(100.0) X 2 = 145.8 <0.0001
30,000–50,000 34(14.0) 209(86.0) 243(100.0)
50,001–100,000 92(25.9) 263(74.1) 355(100.0)
>100,000 131(62.1) 80(37.9) 211(100.0)
Mean ± SD 160004.81 ± 236645.36 75696.82 ± 103393.36 T = 7.4 <0.0001
Are you the head of the household?
Yes 164(26.2) 461(73.8) 625(100.0) X 2 = 13.5 0.0002
No 106(38.4) 170(61.6) 276(100.0)
Location of household
Rural 14(8.8) 145(91.2) 159(100.0) X2 = 41.2 <0.0001
Urban 256(34.5) 486(65.5) 742(100.0)
Do you know anyone who has been on a health insurance plan and has enjoyed it?
Yes 129(69.7) 56(30.3) 185(100.0) X 2 = 175.4 <0.0001
No 141(19.7) 575(80.3) 716(100.0)
Table 4

Predictors of health insurance uptake among respondents

Variables Adjusted OR 95% CI P-value
Age of respondents 1.04 1.03–1.06 <0.001*
LGA of respondents 0.95 0.82–1.11 0.549
Gender 1.04 0.74–1.46 0.831
Religion 0.89 0.64–1.24 0.491
Employment status 1.82 1.24–2.64 0.002*
Level of education 1.41 1.12–1.79 0.004*
Income 1.00 1.00–1.00 <0.001*
Occupation 0.47 0.39–0.57 <0.001*
Location of household 0.96 0.88–1.04 0.302
Rate of health morbidity 0.48 0.38–0.60 <0.001*
Constant 0.10 0.02–0.55 0.008*

* Significant P-value.

3.2 Barriers and facilitators of health insurance uptake in Lagos State

Preventing unforeseen health expenses (56.3%), pressure from health insurance agents (14.8%), and workplace compulsion/part of workplace benefits for self or family (13.1%) were some of the reasons adduced by respondents for enrolling in health insurance. Other reasons include a relation/family paying for it, lack of money for out-of-pocket healthcare expenditures, and no other source of financial help to meet up with health costs (Table 5).

Table 5

Awareness and uptake of health insurance among respondents

Awareness and uptake of health insurance Frequency (N) Percentage (%)
Ever heard about health insurance ( n = 2,487)
Yes 1,352 54.4
No 1,135 45.6
Aware of any health insurance scheme ( n = 1,352)
Yes 897 66.3
No 455 33.7
Ever enrolled in any of the health insurance schemes ( n = 2,487)
Yes 270 10.9
No 2,217 89.1
Schemes respondents are enrolled ( n = 270)
NHIS 50 18.5
PHI scheme 158 58.5
Community-based health insurance scheme 13 4.8
LASHMA (Ilera Eko) 43 15.9
Motivation factors to take a health insurance policy ( n = 270)
To meet the unforeseen expenses 152 56.3
No help from other sources to meet the health expenditure 14 5.2
Due to the pressure of the health insurance agents 40 14.8
Lack of finance to meet the illness 6 2.2
Workplace compulsion/part of workplace benefits 35 13.1
Others 23 21.5
Reasons for non-enrollment (multiple response) ( n = 2,217)
Not aware of how it works 186 8.4
Lack of illness 194 8.8
Financial constraints 548 24.7
Not commensurate benefits 79 3.6
Not enough family support 118 5.3
Heard terrible stories about it 121 5.4
Believe that health insurance companies are fraudulent 95 4.3
Lack of belief in it 349 15.7
Cannot remove from the little I earn for health insurance 167 7.5
Cannot leave my money idle in one place 132 6.0
Spiritual beliefs (my religion does not permit) 42 1.9
Belief that it is not necessary 234 10.6
Others 48 2.2

Financial constraints (24.7%), lack of belief in the concept of health insurance (15.7%), and lack of belief in its necessity (10.6%) were the major reasons for non-enrollment in any health insurance scheme. Others included a lack of frequent illness to warrant enrollment (8.8%), lack of awareness of the modality of health insurance (8.4%), negative feedback and stories about health insurance (5.4%), refusal to put money in a pool to pay for future health costs (7.5%) with a belief that the money is idle and a belief that health insurance companies are fraudulent (4.3%) were also stated as reasons for non-enrollment (Table 5).

3.3 Payment preferences and willingness to pay for health insurance

More than half (57.5%) were willing to continue paying for health insurance if enrolled on a self-paid insurance plan after 1 year if they enjoyed the service while over one-third of respondents (41.7%) were unwilling to continue to pay for health insurance if enrolled freely on a health insurance plan and enjoyed the service. The majority of respondents (71.1%) preferred yearly payments for health insurance premiums and the average cost respondents were willing to pay ranged from N15,000 to N19,000 (12.5–15.8 USD). Most of the respondents (57.7%) were unwilling to continue paying health insurance premiums if they recorded no illness episode during the period of coverage and only a third (32.9%) were willing to encourage co-workers or neighbors to enroll in health insurance schemes should they need it. However, nearly three-quarters of respondents (67.5%) were willing to encourage close relations (family and friends) to enroll in a health insurance scheme (Table 2).

4 Discussion

This study assessed the uptake of health insurance, the barriers and facilitators affecting the uptake of health insurance, and some payment preferences among households in Lagos State. The study revealed a generally below-average awareness of health insurance among residents in Lagos State as almost half of the respondents (45.6%) were not aware of health insurance at all. This was in contrast with similar studies conducted in India and South Africa that generally revealed high awareness of health insurance among urban residents [19,20,21]. However, this finding agreed with a study done in Ibadan [22] which revealed a similar finding of less than average awareness of respondents on the health insurance scheme available. This further validates and serves as a pointer to the low enrollment of health insurance in Nigeria as people will only enroll in what they are generally aware of; this finding becomes more worrisome, especially considering the metropolitan nature of Lagos and the implication on enrollment figures. A lot of awareness drive needs to be conducted to drive the uptake of health insurance in Lagos and Nigeria at large. The uptake of health insurance among respondents in this study was extremely low (10.9%). This finding is consistent with the low coverage that was observed in Tanzania [23] and also reflective of the stories of poor health insurance enrollment across the African continent apart from Rwanda, Gabon, Ghana, and Burundi [24]. The residents who were aware of health insurance schemes were majorly enrolled in PI schemes much more than the Federal Government-owned and operated NHIS and even the Lagos State scheme. This finding was dissimilar to a finding in Nairobi [25], which revealed much more enrollment in publicly funded insurance schemes than PI schemes. This finding underscores that there needs to be more partnerships and collaboration between privately funded insurance schemes and government-funded schemes for effective scaling up of enrollment rates in Nigeria.

Trying to mitigate future health expenditure, workplace compulsion and pressure from health insurance agents were major drivers to the uptake of health insurance as seen in this study. These reasons given were slightly different from some of those adduced for health insurance enrollment in studies done across the African landscape [26,27,28,29]. This may be because of the nature of health insurance in Nigeria which has been largely driven by compulsory enrollment in the Federal government-led NHIS and most private companies’ policy on compulsory health insurance which is extended to their spouses and children. This shows that those who have enrolled are aware of the need to prevent catastrophic health expenditure and also proves that compulsion in enrollment by offices has been a major driver to the uptake of health insurance among Lagosians. One cannot but notice the effect of health insurance agents as drivers for uptake. This places an insight for public insurance scheme managers on adopting the use of agents across various communities to complement other efforts on increasing awareness and uptake. The recent introduction of compulsory health insurance as a law in Nigeria will help drive enrollment; however, its implementation is still suboptimal. Some of the reasons stated by respondents as being responsible for their non-enrollment are somewhat similar to reasons given by previous studies, especially financial constraints and a perceived belief that health insurance is not necessary [30]. There is a need for policymakers to increase awareness of the necessity for health insurance using models that show how catastrophic health expenditure can be and also provide affordable financial schemes to encourage enrollment in health insurance schemes.

This study also revealed most of the individual’s willingness to continue to pay for health insurance if enrolled on either free or self-paid insurance for 1 year provided that they enjoyed the coverage and health benefits. This willingness to continue paying for health insurance waned if no episode of ill health was recorded during the coverage period as less than half of the respondents (42.3%) showed willingness to continue paying. This finding demonstrates that payment for health insurance is contingent on enjoying the health benefits coverage. This is consistent with numerous other findings which also agree that enjoying a health benefit is positively associated with willingness to pay for health insurance schemes [31,32]. On modality and frequency of payments, the majority of the respondents preferred yearly payments and the average amount preferred to pay ranged from 15,000 naira to 19,000 naira (12.5–15.8 USD). A similar study conducted in Sierra Leone revealed a slightly lower amount that was preferred for health insurance premiums [33]. This information provides a baseline amount and duration preference for policymakers to factor in when designing premiums and making decisions on health insurance premium flexibility for Lagos residents.

5 Conclusion

The study has shown that uptake of health insurance remains abysmally low despite relatively average awareness among residents in Lagos State. The need to prevent a catastrophic health event and compulsion were drivers of uptake while financial constraints and a general lack of belief were major barriers that prevented enrollment. More awareness needs to be created by public and private players in the health insurance industry with the aim of educating and enlightening the public, especially those in the informal sector and rural areas. Also, the government needs to enforce the mandatory health insurance scheme while removing all the barriers to the uptake of health insurance among the populace.

5.1 Strengths & limitations of the study

One of the key strengths of our study is the broad community-based approach that spanned across the entire Lagos State. By conducting this research across multiple LGAs within the state, we were able to capture a diverse and representative sample of the state’s population. Furthermore, the large sample size of respondents significantly enhances the robustness and reliability of our research findings.

One of the limitations of our study is the cross-sectional study design nature which limits the ability to establish causality between the factors and health insurance uptake. Also, the study has limited generalizability as the study was conducted only in selected LGAs within Lagos State.

5.2 Implication for policy and future research

Findings from this study have provided insights into the facilitators and barriers influencing the uptake of health insurance among Lagos residents which would enable the development of tailored interventions, resource allocation strategies, and policies aimed at improving awareness; providing affordable and flexible premium options for low-income households; increasing health insurance enrolment and implementing quality assurance measures to build public trust in the insurance schemes. Conducting further research at sub-national or national levels to better understand the predictors of health insurance uptake using longitudinal mixed with qualitative studies, to gain deeper insights into the barriers and facilitators, would be an opportunity for further study.

Acknowledgements

The authors wish to thank the leadership of Lagos State through the Lagos State Ministry of Health and Lagos State Health Management Agency (LASHMA), whose support was critical to the successful completion of this survey. Also, the authors express gratitude to the survey participants for their consent to be part of this study.

  1. Funding information: This survey was made possible through funding from the Bill and Melinda Gates Foundation in partnership with the Lagos State Ministry of Health, Lagos, Nigeria.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and consented to its submission to the journal. All authors have read and approved the final manuscript. Conceptualization: AA (1st author), KOW. Study design: AA (1st author), KOW, and AA (3rd author), data collection and entry: TF, OA, AA (7th author), FO, EZ, HAR, OO, AA (12th author). Data management & statistical analysis: AA (1st author). Manuscript development: OA and AA (7th author). Manuscript review: AA (1st author), KOW.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study were collected in real-time on REDCap hosted at the Lagos State University College of Medicine (LASUCOM) and available from the corresponding author on reasonable request.

References

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Received: 2024-06-05
Revised: 2024-08-15
Accepted: 2024-08-16
Published Online: 2024-09-27

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Artikel in diesem Heft

  1. Research Articles
  2. Predictors of diagnosed cardiovascular diseases and their spatial heterogeneity in Lagos State, Nigeria
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  16. Determinants of health insurance adoption among residents of Lagos, Nigeria: A cross-sectional survey
  17. Enhancing geographical access to cardiovascular disease healthcare services in Lagos State, Nigeria
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  28. Advancing rheumatic disease treatment: A journey towards better lives
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  30. Psychological flexibility and celiac disease in adolescents: Understanding adherence and well-being for enhanced care. A rapid narrative review
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  32. Commentary
  33. Mixed messages, broken trust, avoidable deaths: A critical appraisal of the UK government’s response to the COVID-19 pandemic
  34. The psychological profile of Iraq: A nation haunted by decades of suffering
  35. Metabolic mysteries of the mind: Investigating type 3 diabetes
  36. Ready to bleed when touched – Moral Injury in the Special Operations Forces military population
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  38. Short Communications
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https://doi.org/10.1515/ohe-2023-0043
Schlagwörter für diesen Artikel
health insurance; National Health Insurance Scheme; LASHMA; UHC; Lagos; Nigeria
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Research Articles
  2. Predictors of diagnosed cardiovascular diseases and their spatial heterogeneity in Lagos State, Nigeria
  3. Discourses of risk in public health advertising about underage alcohol consumption
  4. Utilization of health service and associated factors among women in childbearing age in selected internally displaced persons camps, Hargeisa – Somaliland
  5. Healthcare workers’ attitudes toward children getting Covid-19 vaccinations in Gaza Strip
  6. Regional prevalence and spatial modeling of hypertension in South Africa
  7. Immediate effect of mud pack on resting cardiovascular parameters in hypertensive individuals – A single-arm pilot study
  8. An analysis of medical scheme-related pregnancy terminations in South Africa in 2022
  9. Immediate effect of Kaki Mudra on pupillary light reflex among healthy individuals – A study protocol of a Randomized control trial
  10. Healthy lifestyle perceptions and practices among college students at Yanbu University College for Women in Saudi Arabia
  11. Food service management perspectives on reducing sodium content in foods served: Opportunities and challenges
  12. Effects of sanitation on child growth in Serbian Roma communities
  13. College students’ resilience-promoting behaviors and psychological well-being: A latent class analysis
  14. Comparative analysis of household deprivation among Jewish and other religious groups in England and Wales
  15. A study protocol for a randomized controlled trial on the effect of Surya Nadi Pranayama practice on cognitive abilities in school children
  16. Determinants of health insurance adoption among residents of Lagos, Nigeria: A cross-sectional survey
  17. Enhancing geographical access to cardiovascular disease healthcare services in Lagos State, Nigeria
  18. Mortality trends from all causes and diabetes mellitus according to sex between 1998 and 2021
  19. Developing syndrome of inappropriate antidiuretic hormone secretion in Guillain-Barre syndrome
  20. Health professionals’ continuing education attitudes and experiences in food and nutrition sustainability
  21. Nutrition literacy among women participating in a community kitchen program in Antioquia, Colombia: A cross-sectional study
  22. Review Articles
  23. Unraveling PCOS: Exploring its causes and diagnostic challenges
  24. Smart healthcare: Integration of AI and brain cells for advanced healthcare applications
  25. Disrupting the melody: The interplay of obesity and metabolic dysfunction
  26. Comparing global trends in gastric cancer and the need for national screening programs: An in-depth literature review
  27. Social media – Boon or Bane?
  28. Advancing rheumatic disease treatment: A journey towards better lives
  29. Antimicrobial resistance: A significant public health issue of both human and veterinary concern
  30. Psychological flexibility and celiac disease in adolescents: Understanding adherence and well-being for enhanced care. A rapid narrative review
  31. Harnessing real-world evidence in pharmacoeconomics: A comprehensive review
  32. Commentary
  33. Mixed messages, broken trust, avoidable deaths: A critical appraisal of the UK government’s response to the COVID-19 pandemic
  34. The psychological profile of Iraq: A nation haunted by decades of suffering
  35. Metabolic mysteries of the mind: Investigating type 3 diabetes
  36. Ready to bleed when touched – Moral Injury in the Special Operations Forces military population
  37. Towards robust pharmacovigilance surveillance systems
  38. Short Communications
  39. From click to calories: Navigating the impact of food delivery apps on obesity
  40. Long-term economic outlook for Japan, as impacted by COVID-19
  41. Special Issue on Public Health Resilience - Part II
  42. Reframing the response to the opioid crisis: The critical role of resilience in public health
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