AWARENESS AND UTILIZATION OF THE NATIONAL HEALTH INSURANCE SCHEME IN EDO STATE, NIGERIA


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TABLE OF CONTENTS

Title Page
Abstract

CHAPTER ONE: BACKGROUND TO THE STUDY
1.1       Introduction
1.2       Statement of the Research Problem
1.3       Aim and Objectives
1.4.      Research Hypothesis
1.5       Scope of the Study
1.6       Significance of the Study
1.7       Operational Terms
1.8       Organization of the Thesis

CHAPTER TWO: CONCEPTUAL            FRAMEWORK AND LITERATURE REVIEW
2.1       Conceptual Framework
2.1.1    Concept of Health
2.1.2    Evolution of Health Insurance
2.1.3    Concept of Health Care Funding
2.1.4    The “Cash and Carry” System
2.1.5    Community Solidarity in Health Care Funding
2.1.6    Concept of National Health Insurance Scheme
2.2       Awareness of National Health Insurance Scheme  Services
2.2.1    Implementation of National Health Insurance
2.2.2    Payment of Contribution for Health Insurance
2.2.3    Public Expectations of NHIS
2.2.4    Cost of Insurance
2.2.5    Provider Attitude
2.2.6    Economy
2.2.8    Utilization of National Health Insurance Scheme Services
2.2.9    Location/Distance to NHIS Facilities
2.2.10  Accessibility to Health care services
2.2.11  Client‟s Perception of Services
2.2.12 Self-Rated Health Status of participant
2.2.13  Levelof Education
2.2.14  Gender
2.2.15  Culture
2.2.16  Poverty in Health Insurance
2.2.17  Social Factor in Health Insurance
2.2.18 Moral Hazard
2.2.19  Fraud
2.2.20 Adverse Selection
2.2.21  Provider-Related Factors

CHAPTERTHREE: THESTUDYAREAANDRESEARCHMETHODOLOGY
3.1       Study Area
3.1.1    Location
3.1.2 Relief and drainage
3.1.3 Climate
3.1.4 Soils
3.1.5 Vegetation
3.1.6 Historical Growth of Edo State
3.1.7 Population of Edo State
3.7.8    Settlement Pattern of Edo State
3.1.9    Transport System
3.1.10  Economic Activities
3.1.11  Traditional craft and modern industries
3.1.12  Social Organization
3.1.13  Health Care Facilities
3.2       Methodology
3.2.1    Reconnaissance Survey
3.2.2 Sources of Data
3.2.2.1The Primary Sources of Data
3.2.2.2 The Secondary Source of Data
3.2.3    Sample Size and Sampling Technique
3.2.4    Data Analysis

CHAPTER FOUR: RESULTS AND DISCUSSIONS
4.1       Introduction
4.2       Demographic and Socio Economic Characteristics of Respondents
4.2.1    Age
4.2.2    Sex
4.2.3    Religion
4.2.4    Ethnicity
4.2.5    Level of Education
4.2.6    Occupation
4.2.7    Income
4.2.8    Marital Status
4.2.9    Types of marriage
4.2.10  Children Ever-Born
4.2.11  Number of Children Surviving
4.2.12  Types of accommodation
4.2.13  Household Size
4.2.14  Type of Toilet facilities
4.2.16 Access to water
4.2.15 Household gadgets
4.3       Types of Health Care Facilities Available in the NHIS Centres
4.3.1 Reason for Choice of the Center
4.3.3Number of Visits to the Hospital/Clinic in a years
4.3.4 Types of Illness Treated
4.3.5 Distance to the Clinic/Hospital
4.3.6Means of Transportation to the Hospital
4.3.6Time spent at hospital
4.3.7Number of patients treated daily
4.4.7    Type of personnel available at NHIS facilities
4.3.9    Attitude of Health Workers to Patients

CHAPTER FIVE: FACTORS DETERMINING AWARENESS AND UTILIZATION OF NHIS SERVICES
5.1       Introduction
5.2       Awareness of NHIS
5.3       Types of Services and Frequency of Visits
5.4       Types of Health Care Centres and Availability of Facilities
5.5       Religions and Utilization of NHIS Facilities
5.7       Occupation and utilization of NHIS Services
5.8       Ethnic Group and Utilization of NHIS Services
5.9       Marital Status and Utilization of NHIS Services
5.10     Level of Education and Utilization of NHIS services
5.11     Utilization of NHIS Services and Challenges of NHIS Utilization

CHAPTER SIX: SUMMARY, CONCLUSION AND RECOMMENDATION
6.1       Summary
6.2       Recommendations
6.3       Suggestion for Further Research
6.4       Conclusion
REFERENCES
APPENDICES



ABSTRACT

National Health Insurance Scheme (NHIS) is a strategy by the government for reducing maternal, morbidity and mortality rate because adequate utilization of the health care scheme is associated with improved health outcomes. This study investigated awareness and utilization of National Health Insurance scheme in Edo State, Nigeria. Systematic random sampling technique was used to select the 400 respondents from the study area. Data were collected using questionnaire and Focus Group Discussion. Questionnaires collected and analyzed using SPSS version 20.0. Both descriptive and inferential statistic was used to analyze the data generated and the significance level was set at 0.05. Most of the respondents 387 (99.9%) received all the services which includes physiotherapy services, immunization, family planning, eye Examination, preventive dental care, and mental health care.The findings also revealed that majority of the respondents (90%) are aware of NHIS and 65% utilized the scheme. The study found age variance, income, occupation, education, marital status, number of children and religion as a major factors controlling the awareness and utilization of NHIS. Findings revealed a high correlation between income occupation and education levels of respondents and frequency of NHIS usage. The correlation was significant at p ≤ 0.05 levels (α = 0.05). The study also revealed a high correlation between education and income levels of respondents with frequent of NHIS visit that was significant at alpha 0.05. The study recommends that adequate infrastructures, training and evaluation units that should be provided to the scheme that able to keep corruption under control and among others although awareness is high. However there should be intensive sensitization and mobilization by the health department in the following areas which include Akoko Edo,Esan-West and Uhunmwode.




CHAPTER ONE: BACKGROUND TO THE STUDY


1.1            INTRODUCTION
The need for the National Health Insurance Scheme (NHIS) in Nigeria came up as a

result of poor health indices, high mortality rate, and poor state of healthcare services, excessive dependence on government health facilities, pressure on public health facilities and poor integration of private health facilities into the nation‟s healthcare delivery system

(NHIS, 2012). National Health Insurance Scheme (NHIS) was first introduced to parliament in the year 1962 when the need for health insurance in the provision of health care to Nigerians was first recognized. It was fully approved by the federal government in 1997 and signed into law in 1999. The scheme was officially launched on the 6th of June, 2005.
National Health Insurance Scheme (NHIS) is a cooperate body under act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at affordable cost. The NHIS is a social security system in which the health care of employees in the formal sector is paid from funds created by pooling of contribution of employers and employees. Beneficiaries to the scheme include students of tertiary institutions.

The objectives of the NHIS scheme are to among others; ensure that every Nigerian has access to good health care services while protecting families from the financial hardship of medical bills. Under the scheme, health care providers, referred to as Health Maintenance Organizations (HMOs) are responsible for providing and making payments for all persons who have registered and have paid the required premium. To provide this service, the HMOS liaise with the accredited medical establishment of a person‟s choice

(ABU, 2013). The rising cost of health care services and the need to provide quality.....

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