THE EFFECT OF HEALTH INSURANCE SCHEME ON THE UTILIZATION OF HEALTH CARE SERVICES BY ANGLICAN CHURCH WORKERS IN ANAMBRA STATE

Abstract

Paying for health services at the point of service can be quite challenging to many people and have been found to impoverish many families. Health insurance helps the user to pre-pay for the services when there were no challenges. This study was done to determine the effect of introduction of health insurance on the access to, utilization of healthcare services and health expenditure of Anglican church workers in Anambra State.
In this quasi-experimental study, data was collected from the church workers using a pre-tested, structured, self-administered questionnaire. Key informant interviews were conducted with the bishops of the participating dioceses using an interview guide. All the clergy and church teachers (223) in the dioceses of Aguata and Ogbaru were used as the intervention group, while the clergy and church teachers in the dioceses of Nnewi and Ihiala (246) served as control. Analysis was done with Microsoft Excel and IBM-SPSS statistics version 20 software. Relative proportions, means and associations were compared using chi-square, t-test and analysis of variance with the significance level set at 5%.
A health insurance scheme was successfully initiated for the church workers. The prevalent health problems self-reported among church workers were malaria 168 (86.6%), typhoid fever 102 (57.6%), cough/catarrh 89 (45.9%) and stress 39 (20.1%). The church workers had no problem accessing healthcare but the health insurance scheme further improved access to healthcare. The utilization of private hospitals by church workers did not significantly increase but the use by family members significantly increased from pre-intervention level of 237 visits over three months (1.17±1.5) to 357 (1.81±1.7) (p<0.001) post-intervention. There was however, significant reduction in the use of facilities that did not serve as healthcare providers for the health insurance scheme such as patent medicine stores (p<0.001), pharmacy outlets (p<0.001), general hospitals (p=0.037), primary healthcare centers (p=0.008) and laboratories (p=0.004). The church workers had a good perception of health insurance which was not significantly influenced by being enrolled in a scheme. Due to the introduction of the health insurance scheme, the average monthly total health expenditure per household reduced from N15,984.75±16,325.41 to N6,268.54±3,337.13 (p<0.001). The average monthly out-patient expenditure reduced from N8,792.64±7,505.50 to N5,507.11±2,200.69 (p<0.001). The average monthly in-patient expenditure also reduced from N2,389.06±5,830.05 to N101.51±706.92 (p<0.001).
Based on the findings it was concluded that health insurance improved access to healthcare, improved utilization of health care at hospitals that served as providers and discouraged the use of other facilities that were not providers for the scheme, and reduced health care expenditure. Other homogenous groups should be encouraged to organize their own health insurance schemes and the Board of Trustees of such groups allowed to manage the schemes without the involvement of Health Maintenance Organizations

THE EFFECT OF HEALTH INSURANCE SCHEME ON THE UTILIZATION OF HEALTH CARE SERVICES BY ANGLICAN CHURCH WORKERS IN ANAMBRA STATE