The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria
In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the ut...
| Autores principales: | , , , , , , , |
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| Formato: | Journal Article |
| Lenguaje: | Inglés |
| Publicado: |
Oxford University Press
2020
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| Acceso en línea: | https://hdl.handle.net/10568/142626 |
| _version_ | 1855513512620589056 |
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| author | Nelissen, Heleen E. Brals, Daniëlla Ameen, Hafsat A. van der List, Marijn Kramer, Berber Akande, Tanimola M. Janssens, Wendy van’t Hoog, Anja H. |
| author_browse | Akande, Tanimola M. Ameen, Hafsat A. Brals, Daniëlla Janssens, Wendy Kramer, Berber Nelissen, Heleen E. van der List, Marijn van’t Hoog, Anja H. |
| author_facet | Nelissen, Heleen E. Brals, Daniëlla Ameen, Hafsat A. van der List, Marijn Kramer, Berber Akande, Tanimola M. Janssens, Wendy van’t Hoog, Anja H. |
| author_sort | Nelissen, Heleen E. |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage. |
| format | Journal Article |
| id | CGSpace142626 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2020 |
| publishDateRange | 2020 |
| publishDateSort | 2020 |
| publisher | Oxford University Press |
| publisherStr | Oxford University Press |
| record_format | dspace |
| spelling | CGSpace1426262025-02-24T06:46:59Z The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria Nelissen, Heleen E. Brals, Daniëlla Ameen, Hafsat A. van der List, Marijn Kramer, Berber Akande, Tanimola M. Janssens, Wendy van’t Hoog, Anja H. expenditure health insurance drugs health quality rural areas health care In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage. 2020-03-01 2024-05-22T12:10:46Z 2024-05-22T12:10:46Z Journal Article https://hdl.handle.net/10568/142626 en https://doi.org/10.1016/j.worlddev.2018.07.004 https://doi.org/10.1016/j.ijcard.2015.09.036 https://doi.org/10.1093/wber/lhx001 https://doi.org/10.2499/p15738coll2.133514 Open Access Oxford University Press Nelissen, Heleen E.; Brals, Daniëlla; Ameen, Hafsat A.; van der List, Marijn; Kramer, Berber; Akande, Tanimola M.; Janssens, Wendy; and van’t Hoog, Anja H. 2020. The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria. Health Policy and Planning 35(3): 354–363. https://doi.org/10.1093/heapol/czz172 |
| spellingShingle | expenditure health insurance drugs health quality rural areas health care Nelissen, Heleen E. Brals, Daniëlla Ameen, Hafsat A. van der List, Marijn Kramer, Berber Akande, Tanimola M. Janssens, Wendy van’t Hoog, Anja H. The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria |
| title | The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria |
| title_full | The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria |
| title_fullStr | The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria |
| title_full_unstemmed | The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria |
| title_short | The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria |
| title_sort | prominent role of informal medicine vendors despite health insurance a weekly diaries study in rural nigeria |
| topic | expenditure health insurance drugs health quality rural areas health care |
| url | https://hdl.handle.net/10568/142626 |
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