THE IMPACT OF HEALTH CARE INSURANCE PLANS: A CASE STUDY OF LUTH IN IDI-ARABA, SURULERE, LAGOS.


THE IMPACT OF HEALTH CARE INSURANCE PLANS: A CASE STUDY OF LUTH IN IDI-ARABA, SURULERE, LAGOS. 

TABLE OF CONTENT

Title Page………………..i

Certification……………ii

Dedication………………iii

Acknowledgment……….iv

Abstract…………………vi

Table of content………vii

CHAPTER ONE

INTRODUCTION

1.1              Background of the study

1.2       Statement of the problem

1.3       Objectives of the study

1.4       Research questions

1.5       Research hypotheses

1.6       Significance of the study

1.7       Scope of the study

1.8       Limitations of the study

1.9       Definition of terms

REFERENCES

CHAPTER TWO

LITERATURE REVIEW

2.1 AN OVERVIEW OF HEALTHCARE SERVICES DELIVERY

IN NIGERIA

2.2 THE GOALS OF NATIONAL HEALTH POLICY

2.3 IMPERATIVES OF IMPROVED HEALTHCARE

SERVICES DEVELOPMENT

2.4 FINANCING OF HEALTHCARE SERVICE IN NIGERIA

2.5 THE NATIONAL HEALTH INSURANCE SCHEME (NHIS)

2.6 NATIONAL HEALTHCARE INSURANCE SCHEME

PLANS

2.7 HEALTHCARE SERVICES OF NATIONAL HEALTH

INSURANCE SCHEME

2.8 EXCLUDED SERVICES FROM THE NHJS SCHEME

2.9 MANAGEMENT OF THE NATIONAL HEALTH INSURANCE SCHEME (NHIS)

2.9.1 The National Health Insurance Scheme Act provides for the

Mowing in the management of the scheme;

2.9.2 HEALTH MAINTENANCE ORGANIZATION (HMOS)

2.9.3 HEALTH SERVICES PROVIDERS (HSPs)

2.9.4 FUNDING OF THE SCHEME

2.9.5 OPERATIONAL PROCEDURES AND COVERAGE

2.10 EVALUATION OF THE NHIS

2.11 PROBLEMS AND PROSPECTS OF THE NHIS

REFERENCES

CHAPTER THREE

METHODOLOGY

3.1 Research Design

3.2 Population of the Study

3.3 Sampling and sampling technique

3.4 Instrument/Method of Data Collection

3.5 Validity and Reliability of the Instrument

3.6 Method of Data Analysis

CHAPTER FOUR

PRESENTATION AND ANALYSIS OF RESULTS

4.1 Demographic Information of the Respondents

4.2 Answers to the Research Questions

4.3 Research Hypotheses

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION

5.1       SUMMARY OF FINDINGS

5.2       CONCLUSION AND RECOMMENDATION

QUESTIONNAIRE 

CHAPTER ONE

INTRODUCTION

Background of the study

Health care insurance plan has been a growing concern to many developing countries in recent times. Given that health insurance is designed to cover formal and informal sectors, rural and urban locations, low and high income earners, it becomes critical as well as a challenge for developing countries as they seek to design, operate and manage effective health insurance system that benefit all citizens. According to Mossialos et al. (2002) there are basically five forms of health financing available to any country. These include taxation; social health insurance; voluntary and private insurance; out-of-pocket or cash-and-carry; and donations. It is said that identifying a sustainable source of financing health care in the world has indeed become a major issue for discussion across the world’s powerful institutions and stakeholders. The United Nation and other groupings andorgans representing the continents of the world are developing strategies for sustainable health care insurance plan. According to the World Health Organization (WHO), supporting adequate, sustainable, equitable and effective health financing to improve health outcomes is one of the most important goals of the World Health Organization. The Executive Board of WHO and the fifty-eight World Health Assembly have discussed and provided strategic directions on sustainable health financing, universal coverage and social health insurance.

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" Health care insurance plan has been a growing concern to many developing countries in recent times. Given that health insurance is designed to cover formal and informal sectors, rural and urban locations, low and high income earners, it becomes critical as well as a challenge for developing countries as they seek to design, operate and manage effective health insurance system that benefit all citizens. According to Mossialos et al. (2002) there are basically five forms of health financing available to any country. These include taxation; social health insurance; voluntary and private insurance; out-of-pocket or cash-and-carry; and donations. It is said that identifying a sustainable source of financing health care in the world has indeed become a major issue for discussion across the world’s powerful institutions and stakeholders. The United Nation and other groupings andorgans representing the continents of the world are developing strategies for sustainable health care insurance plan. According to the World Health Organization (WHO), supporting adequate, sustainable, equitable and effective health financing to improve health outcomes is one of the most important goals of the World Health Organization. The Executive Board of WHO and the fifty-eight World Health Assembly have discussed and provided strategic directions on sustainable health financing, universal coverage and social health insurance.

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" Health care insurance plan has been a growing concern to many developing countries in recent times. Given that health insurance is designed to cover formal and informal sectors, rural and urban locations, low and high income earners, it becomes critical as well as a challenge for developing countries as they seek to design, operate and manage effective health insurance system that benefit all citizens. According to Mossialos et al. (2002) there are basically five forms of health financing available to any country. These include taxation; social health insurance; voluntary and private insurance; out-of-pocket or cash-and-carry; and donations. It is said that identifying a sustainable source of financing health care in the world has indeed become a major issue for discussion across the world’s powerful institutions and stakeholders. The United Nation and other groupings andorgans representing the continents of the world are developing strategies for sustainable health care insurance plan. According to the World Health Organization (WHO), supporting adequate, sustainable, equitable and effective health financing to improve health outcomes is one of the most important goals of the World Health Organization. The Executive Board of WHO and the fifty-eight World Health Assembly have discussed and provided strategic directions on sustainable health financing, universal coverage and social health insurance.

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" 

1.2   Statement of the problem

Health care insurance has become a global challenge to all countries and all persons. The ability of national governments to provide funding for health care and to sustain the funding is a huge responsibility, Nigeria is no exception. New and innovative ways are being developed by Governments all over the world to ensure that basic health care is available to all at affordable prices and is equitable. In line of the above, the study was conducted to find out the impact of health care insurance plan in Nigeria.

1.3   Objectives of the study

1. To determine the impact of health care insurance plan have on Nigerians.

2. To identify the relationship between health care and insurance plan.

1.4   Research questions

1. What impact does health care insurance plan have on Nigerians?

2. Is there a relationship between health care and insurance plan?

1.5   Research hypotheses

Ho: There is no significant impact of health care insurance plans in Nigeria.

Hi: There is significant impact of health care insurance plans in Nigeria.

Ho: There is no relationship between health care and insurance plan.

Hi: There is a relationship between health care and insurance plan.

1.6   Significance of the study

Health insurance is a health insurance risk hedged against the probability that if and when someone unexpectedly becomes sick, requires expensive treatments, or is at the mercy of a chronic condition that requires long-term care they will not fall into dire financial straits.It is a benefit provided through a government agency, private business, or non-profit organization.

High-quality health care affects health and wellness. A health insurance policy is a contract between an insurance company and a policy holder intended to safeguard against high and unexpected health care costs. Although policy-holders pay a monthly premium, co-payments, co-insurance, and deductibles, it is expected that the total is far less than that required if paid fully out-of-pocket.

Coverage from a health insurance policy or a public health program can greatly relieve the financial burden of health care expenses. Those who are uninsured or underinsured can experience financial strain and require assistance from alternative funding sources which may not be available at that time. This study will be educative as it will inform people about the enormous benefit of health care insurance plan and it will also be a reference point for researchers.

1.7   Scope of the study

The study focuses on the impact of health care insurance plans in Nigeria using Lagos University Teaching Hospital (LUTH) in Idi-Araba, Surulere Local Government Area of Lagos State, Nigeria as the case study.

1.8   Limitations of the study

This study has some limitations most especially in the area of data collection. Financial constraints as well as time available for the completion of the study are among other factors that would limit the scope of the study.

1.9   Definition of terms

Health Care: The maintaining and restoration of health by the treatment and prevention of disease especially by trained and licensed professionals (as in medicine, dentistry, clinical psychology, and public health).

Insurance:An arrangement by which a company or the state undertakes to provide a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a specified premium.

Group Health Insurance Plan:An insurance plan that provides healthcare coverage to a select group of people.

REFERENCES

Atim, C., 1998. Contribution of mutual health organizations to financing, delivery and access to health care: Synthesis of research in nine west and central african countries.

Ekman, B., 2004. Community-based health insurance in low-income countries: A systematic review of the evidence. Health Policy and Planning, 19: 257-271.

Filmer, D., J. Hammer and L. Pritchett, 1997. Health policy in poor countries: Weak links in the chain. Washington, DC: The World Bank.

Forgia, L., G. and C. Griffin, 1993. Health insurance in practice: Fifteen case studies from developing countries.

Hoffmeyer, U. and T. McCarthy, 1994. Financing health care. Dordrecht: Kluwer Academic Publishers.

Hsiao, W.C., 1995. Medical savings accounts: Lessons from singapore. Health Affairs, 7(4): 260-266.

Jesse, M. and O. Schaefer, 2000. Health care systems in transition ,estonia. Copenhagen. European Observatory on Health Care Systems.

Johnson, J.A. and C. Stoskopf, 2009. Comparative health systems: Global perspectives. Massachusetts. Jones and Bartlett Publishers.

Langenbrunner, J., A. Preker and M. Jakab, 2001. Resource allocation and purchasing of health services in developing countries. Washington, DC. : World Bank.

CHAPTER TWO

LITERATURE REVIEW

2.1 AN OVERVIEW OF HEALTHCARE SERVICES DELIVERY

IN NIGERIA

An important question most health experts have tired to address in discussing healthcare services delivery in Nigeria has been: "what really determines the overall health condition of the Nigerian populace" one obvious possible answer is health services, and the number of physicians or hospital beds as well as availability of drugs and other related factors. According to Soyinka (2000:19) good health is one of the most important basic needs of mankind and is indispensable in social and economic development of a nation. The Nigerian governments had recognized the need good healthcare services for the nation and have been purchasing the objective of adequate healthcare services delivery since the nation attained political independence in 1960.

Although the nation's health facilities were not developed as they are today, it is acknowledge that healthcare services delivery was efficient and effective in most parts of the country in the 1960s and 1970s.

According to Dimeji (2000:10), it was a period all levels of government were very much committed to ensuring adequate health care services even with the limited health personnel and physical facilities. Health considerations were taken into account in all development planning then rather than having health regarded as a matter of giving money to the Ministry of Health for a new hospital or adding a clinic to a development project. A comparative study on healthcare service in Nigeria for the periods 1960 - 1980 and 1981 - 2000 showed that there were fever number of medical and health personnel, hospital and other health facilities in the country in 1960 - 1980 period i.e. fever number of doctors, nurses, hospital, clinics and community health centers.

Dimeji (2000: 10) remarks that despite the high doctor - patient and nurse - patient ratios health service were more effective and effective than what obtained in the period 1980 - 2000. although there was rapid expansion of health facilities in the second half of the 1970s due to oil boom that saw budgetary allocation expanded in the health sector, the rapidly growing population more than offset the progress in the second half of the 1980s to the 1990s.

This finding was collaborated by that of the world Health Organization (2001:42) that showed a marked deterioration in Nigeria's health care services delivery in 1985 - 1995 relative to 1975 - 84 period. It was found that over these periods, there had often been much emphasis on sophisticated and expensive clinical practice in large urban hospitals.

At the same time, environmental health, water supply and sanitation had generally received little emphasis until the 1990s, except to a little extent in a few major cities.

While this may have corresponded to the realities of powerful social and political forces - the vested interests of an urban elite and of the medical profession - such activities have scarily touched the health problems of hebulk of the population, who often live in rural areas out of reach of official personnel services and whose health situation is hardly affected by episodic curative health care.

RamesomeKuti (1992:17) posits that it is this discouraging healthcare condition that informed the launching of the Primary Healthcare Services Scheme in 1990. Under this scheme, there was proliferation of public and private health intuitions and facilities throughout the country. Since then there is at least one private health institution in every town and one public health institution in each local government throughout the country (Mba, 2002:8).

The rapid expansion of private health care institutions since the mid - 1980s represents a milestone in the quest for improved healthcare services delivery in the country. This then called for effective integration of the private health institutions into the National Health Policy so as to ensure effective provision of healthcare service throughout the country.

.

THE IMPACT OF HEALTH CARE INSURANCE PLANS: A CASE STUDY OF LUTH IN IDI-ARABA, SURULERE, LAGOS.



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