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European Journal of Applied Sciences – Vol. 10, No. 5
Publication Date: October 25, 2022
DOI:10.14738/aivp.105.12446.
Akinremi, A. O., Coker, M. O., Dosunmu, A. O., Adejumobi, O. M., Adeniregun, A. O., & Edun, F. O. (2022). Baseline Assessment
Towardsthe Implementation of Formal Sector Health Insurance Scheme for Civil Servants in Ogun State of Nigeria. European Journal
of Applied Sciences, 10(5). 309-359.
Services for Science and Education – United Kingdom
Baseline Assessment Towards the Implementation of Formal
Sector Health Insurance Scheme for Civil Servants in Ogun State
of Nigeria
Amos Oluwasayo Akinremi
Ogun State Health Insurance Agency, Nigeria
Marcellina Oluwatomi Coker
Ogun State Ministry of Health, Nigeria
Afolabi Oladimeji Dosunmu
Ogun State Health Insurance Agency, Nigeria
Oluwabukola Moyo Adejumobi
Ogun State Health Insurance Agency, Nigeria
Adedapo Olugbenga Adeniregun
Ogun State Health Insurance Agency, Nigeria
Folarin Opeyemi Edun
Ogun State Health Insurance Agency, Nigeria
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310
European Journal of Applied Sciences (EJAS) Vol. 10, Issue 5, October-2022
Services for Science and Education – United Kingdom
ABSTRACT
The healthcare financing mechanism of a nation generally determines the access of
her people to the needed qualitative and affordable health care services without
undergoing any financial hardship, This study is therefore set to determine among
other things the preferred mode of service payment for healthcare, as a measure of
demand for health insurance, among civil servants in Ogun State of Nigeria. The
study adopted a “quantitative methodology” approach, with the use of pretested
self-administered questionnaires. The mean age of the respondents was 37.85
years ± standard deviation of 7.51 years. In setting the health insurance premium,
majority, 59.3% of the respondents preferred government use percentage of gross
salary rather than estimated amount. They suggested around 2.18% of their gross
salary as premium and an additional 30.26% of their gross salary as contribution
to the premium from their employer. On an average, they were only willing to pay
one thousand seven hundred and eighty naira and 32 kobo (N1,780:32) in a month
to have themselves, their spouse and 4 dependants covered by an health insurance
scheme. The study indicated the predictors of demand for health insurance as being
married, having spent 10 years and more in civil service, and perceived importance
(value) of health insurance. The latter implies that there is an association between
value attached to health insurance and its demand such that those who felt health
insurance was important were 6 times more likely to prefer it as method of service
payment than those who did not see the importance of health insurance.
Key Words: demand for health insurance, moral hazard, civil servants, access theory,
utility theory
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311
Akinremi, A. O., Coker, M. O., Dosunmu, A. O., Adejumobi, O. M., Adeniregun, A. O., & Edun, F. O. (2022). Baseline Assessment Towards the
Implementation of Formal Sector Health Insurance Scheme for Civil Servants in Ogun State of Nigeria. European Journal of Applied Sciences, 10(5).
309-359.
URL: http://dx.doi.org/10.14738/aivp.105.12446
INTRODUCTION
Background information
The healthcare financing mechanism of a nation generally determines the access of her people
to the needed qualitative and affordable health care services without undergoing any financial
hardship. It has been documented that both the policy plan and execution of an appropriate
health financing method are critical in achieving universal health coverage [1]. In Nigeria,
access to healthcare as a central part of the entire healthcare system has been plagued with
several challenges with regards to cost of health care services and financial capacity to offset
the bills. Therefore, similar to other social services, people do not have equal access, thus, a key
barrier to realizing the target of health care for all; that is, universal health coverage; continues
to be limited physical access to basic health care. In view of this, there is need for government
to design and implement a health financing system capable of bringing “health care services
closer to people across economic divides and different social strata” [2]. This is essentially
to decrease the restraint of finance in accessing health care services.
Meanwhile, healthcare is an essential public good and a key factor in the development of a
nation as investment in the health of the general populace would possibly improve the state
economy since health increases labour effectiveness and personal productivity through
increased body fitness and mental capacities, which are essential for economic advancement
[2]. Furthermore, Olakunde [3] identified health as the first wealth of a nation because of the
evidence from empirical studies which demonstrated that the health of a country significantly
boosts her economic development [4]. For now, health insurance is generally believed to be a
useful instrument to achieve universal health coverage, and there are many postulated theories
to help understand factors that influence its demand. This work will thus contribute to the
theories of decision-making in the context of health insurance as discussed by Schneider [5]. It
was indicated that the generally acceptable and available mode of payment for healthcare
services in a nation is a chief predictor of the health of her populace [1, 3].
This study is therefore set to determine among other things the preferred mode of service
payment for healthcare (to measure demand for health insurance) among civil servants in Ogun
State of Nigeria as the State Government plans to introduce formal health insurance scheme for
civil servants across the state. In view of this, Ogun State Health Insurance Agency was created
on 27th May, 2019 after the successful passage of the health insurance bill by the state house of
assembly which the state governor signed into Law No: 039/2018. The State had initially
piloted a Community-Based Health Insurance Scheme (CBHIS) under the State Primary Health
Care Development Board with the official flag-off on 29th April 2014, and later created a
Department of Health Insurance under the State Ministry of Health with the official scale up of
the CBHIS in July 2016. This path to universal health coverage (UHC) is aimed at building a
healthier and more equitable society as millions of the citizens are being driven into abject
poverty because they have to fund health care services from their own pockets. It is one very
fundamental concept; a strong social equalizer and the utmost demonstration of fairness,
especially in this world of social inequalities in levels of income and health care access.
Meanwhile, Schneider [5] indicated that CBHIS is generally implemented in the agricultural or
informal sectors. In places where social health insurance is not available, it can also be offered
to formal sector groups. He however identified that the small size of various CBHIS suggested