Urban Self-employed Social Health Insurance Program as an Option in Financing Health Care within the Informal Sector? An Insight into the Acceptability of the Scheme by the Self-employed in Rivers State, Nigeria

Abstract

Introduction: Health care financing in the Nigerian health sector has been a major impediment within the sector due to increasing healthcare costs. Various forms of financing mechanisms are employed within the country with majority tilting to out-of-pocket payment, which led to the launch of the National Health Insurance Scheme in 2005. The National Health Insurance Scheme has the ambition to provide universal coverage to the population in 15-20 years, but the scheme had its limitations in achieving universal health coverage because it is limited to federal government civil servants neglecting the informal sector, which includes self-employed individuals. Although other forms of social health insurance scheme are being implemented within the country such as the Community Based Health Insurance Scheme. There is no sufficient evidence on the actualization of a health insurance program specifically for the self-employed despite its presence in the health insurance package known as Urban Self-Employed Social Health Insurance Program. This study aims to ascertain the perceived impact and acceptability of the Urban Self-employed Social Health Insurance Program as a viable option in financing healthcare among the self-employed. Methodology: This was a cross-sectional descriptive study of 204 self-employed individuals who were selected from seven different trade associations in Port Harcourt using semi-structured interviewer-administered pre-tested questionnaires. A Socio-Economic Status index was used to divide the households into quintile. The respondents rated their perception about the possible benefits of health insurance from 1 (none) to 4 (high) and the willingness of respondents to enrol in a community-based health insurance scheme (elicited as a binary ‘yes’ or ‘no’ variable) was also used as a proxy of acceptability data collected were analysed using the statistical package for social science (SPSS), version 23 software. Result: A majority 201 (98.5%) of the respondents perceived that having any form of insurance has the potential to improve access to health care and affordable. Respondents gave responses rated with an average mean of 3, which translates to medium impact on financial protection, improved access to healthcare, affordability and improving quality of treatment. Most respondents 183 (89.7%) accepted the urban self-employed health insurance scheme as a strategy for financing healthcare. Conclusion: Urban Self-Employed Social Health Insurance Program appears to be a viable and acceptable method of paying for healthcare among the self-employed in Port Harcourt city of Rivers State, Nigeria.