Knowledge, accessibility and uptake of national health insurance authority and the negative economic effects of non-users in a rural community in South Western

Eniola AO; Michael FO; Andrew OA; Leke FM; Rodney OD; Pelumi OJ; Michael EO; Ezekiel AT; Kokogho EO; Aisha IA; Abisola OO; Fatimah GA; Ikpor JE; Olatilewa AD; Miracle AC; Blessing OT; Blessing OU; Osedebamen OW; Efezino MH

doi:10.61386/imj.v18i4.811

Authors

Eniola AO Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Michael FO Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
Andrew OA Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
Leke FM Faculty of Law, Thomas Adewumi University, Oko, Kwara State, Nigeria https://orcid.org/0000-0002-1620-1523
Rodney OD Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Pelumi OJ Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Michael EO Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Ezekiel AT Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Kokogho EO Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Aisha IA Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Abisola OO Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Fatimah GA Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Ikpor JE Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Olatilewa AD Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Miracle AC Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Blessing OT Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Blessing OU Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Osedebamen OW Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
Efezino MH Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria

DOI:

https://doi.org/10.61386/imj.v18i4.811

Keywords:

Health insurance, NHIA, out-of-pocket payments, economic burden, healthcare access, Ido-Ekiti

Abstract

Background: The National Health Insurance Authority (NHIA) was established to reduce out-of-pocket (OOP) spending and improve healthcare access in Nigeria. Despite its potential, access to the scheme remains limited, especially in semi-urban communities like Ido-Ekiti, Ekiti State, leading to potential economic burdens. This study assessed the economic effects of inaccessibility to the NHIA among residents of Ido-Ekiti, Ekiti State.

Materials/Methods: A descriptive cross-sectional study was conducted among 415 residents aged 18 years and above in Ido-Ekiti. Participants were selected using a multistage sampling method with probability proportionate to size (PPS). Data were collected over eight weeks using self-administered questionnaires and analyzed using IBM SPSS version 25.

Results: Out of 415 respondents, 30.9% were aged 35–44 years. While 64.7% were aware of health insurance, 61.8% had poor knowledge of it. Only 17.4% were enrolled in NHIA. A significant proportion (52.0%) reported economic challenges linked to healthcare inaccessibility, including delayed care and borrowing money for medical bills. Most respondents attributed these challenges to OOP health expenditures due to non-enrollment.

Conclusion: Despite relatively high awareness, poor knowledge and limited access to NHIA persist, contributing to economic hardship among residents. Strengthening awareness, improving service quality, and establishing trust-building mechanisms are essential for expanding NHIA uptake.