Acta Scientific Microbiology

Research Article Volume 7 Issue 2

National Health Insurance Scheme: Effect of Out-of-Pocket Payment and Access to Health Services. A Case Study of Federal Medical Center, FMC, Jabi, Abuja

Ajobiewe JO1, Adati Wasinda Kefas3, Ajobiewe HF2, Akinloye Oyetunde7, Patrick Pillah1, Victoria Pillah4, Alau Kenneth5, Aisha Salami6, Yashim AN7

1Veritas University Nasarawa State Nigeria, Nigeria
2Binham University Karu Nasarawa State of Nigeria
3National Open University Dutze Study Center Abuja
4Nigerian National University Commission ' NUC'
5Health System Consults Limited ( HSCL) Abuja
6United State Department of Defense, Walter Reed Program Nigeria US Embassy Nigeria
7Baze University Abuja Nigeria

*Corresponding Author: Ajobiewe JO, Veritas University, Bwari Abuja, Nigeria.

Received: March 03, 2023; Published: January 26, 2024


A crucial element of universal healthcare is health insurance, which offers financial protection against the expenses of utilizing medical services. Nigeria is one of several African nations where a sizable amount of current health spending is made up of out-of-pocket expenses. The percentage of out-of-pocket spending has remained steady over the past 20 years. The Federal Medical Center (FMC) Jabi in Abuja is where the investigation was conducted. FMC Jabi institution is situated in Nigeria's northern central region. Clients who visited the research facility were given questionnaires by the interviewer. The poll included 500 customers, including men and women between the ages of 25 and 60. The vast majority of them (78%) were above the age of 30. There were 200 men and 300 women present, accounting for 40% of the total. The male: female ratio was 1:1.5, 109 (21.8%) and 17 (3.4%) people were single or divorced despite the fact that 339 (67.8%) of the participants were married. A total of 317 (63.4%) participants, or 100 (20%) and 83 (16.6%), are not public officials or employees of the government. More than half of the participants had monthly incomes below the minimum wage. Household heads are working part-time or being unemployed more frequently these days. In contrast to the WHO requirement of 40% or less, which implies catastrophic household health spending, the mean values of patients who could afford to enroll in the NHIS, undergo extensive medical diagnostics, and purchase pharmaceuticals were/those that cannot stands at 34 (CI 31.8-36.2)/122 (CI 119.8-124.2)/60. The study's findings show the impact of out-of-pocket expenses and payments on access to universal healthcare in the twenty-first century, but the values obtained may be woefully insufficient to inform governmental policy decisions about the amount of money needed to fund the suggested package for patients under the national health insurance program (NHIS). This is true because household health costs are significantly influenced by socioeconomic position.

Keywords: National Health Insurance Scheme; NHIS; Out-of-Pocket; Unemployed; Federal Medical Center; FMC


  1. Ataguba JE and Ingabire M-G. “Universal Health Coverage: Assessing Service Coverage and Financial Protection for All”. American Journal of Public Health 10 (2018): 1780-1781.
  2. Mills A., et al. “Equity in financing and use of healthcare in Ghana, South Africa, and Tanzania: implications for paths to universal coverage”. The Lancet 9837 (2019): 126-133.
  3. Van Doorsalaer E., et al. “Catastrophic payments for healthcare in Asia”. Health Economics (2019).
  4. WHO, World Health Statistics (2020).
  5. Hoare G. “Policies for financing the Health sector. (2nd). Health Policy and Planning Human development report on fighting climate change. (2018). UNDP (2019).
  6. World development indicators. World Bank (2018).
  7. Shaw RP and Grinnin CC. “Financing Healthcare in sub-Saharan Africa through user fees and insurance”. World Bank (2021).
  8. “Women, Poverty and Economics” (2018).
  9. Gwatkin DR. “How well do Health program reach the poor. (361st ed.)”. Lancet (2018).
  10. Ekunwe EO. “Nigeria primary health care delivery system: The challenge of implementation”. Blaze publication (2019).
  11. Green A. “An introduction to Health Planning in developing countries (2nd)”. Oxford University Press (2020).
  12. Huber G., et al. “Mutual health organization, five years in West Africa”. German technical organization report (2019).
  13. Cameron A., et al. “Medicine prices, availability, and affordability, in 36 developing and middle-income countries: A secondary analysis. (373rd, Vol. 9659) (2019).
  14. World Health statistics. WHO (2019a).
  15. Gottret P and Schieber G. “Health financing revisited: A practitioners guide”. The World Bank (2019).
  16. Criel B and Van Dormael M. “Mutual health organization in Africa and social health insurance systems: Will European history repeat itself? (4th, Vol. 3)”. Tropical Medicin and International Health (2019).
  17. Ndiaye P., et al. “A review from beneath: Community health insurance in Africa. (12th, Vol. 2)”. Tropical Medicine and International Health (2020).
  18. Wagner A., et al. “Access to care and medicines, burden of healthcare expenditures, and risk protection: Results from the world health survey”. Health Policy 2-3 (2019): 151-158.
  19. Wagner A and Ross-Degnan D. “Insurance system in the Asia-Pacific regions: Improving appropriate use of and access to medicines”. Prescribing Culture and Pharmaceutical Policy in the Asia-Pacific (2020).
  20. Xu K., et al. “Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditure in Uganda”. Social Science and Medicine4 (2019): 866-876.
  21. Xu K., et al. “Protecting households from catastrophic health spending. (26th, Vol. 4)”. Health Affairs (2018).
  22. Xu K. “Distribution of health payments and catastrophic expenditures methodology” (2018).
  23. Xu K., et al. “Household Catastrophic health expenditure: A multi country analysis. (362nd, Vol. 9378)”. The Lancet (2019).
  24. Bloom G. “China in transition: Challenges to urban health services”. In Transition in urban China by Bloom G. and Tang S.H. (ed), Asgate Publishing Limited, England (2019): 127-142.
  25. European Commision. “Development of a methodology for collection and analysis of data on efficiency and effectiveness in healthcare provision”. 4th Health System Working Party Meeting (2020).
  26. Emmett B. “Abolishing cost recovery in basic healthcare: A critical reform for Africa” (2018).
  27. Gilson L and McIntyre D. “Removing user fees for primary care in Africa: The need for tcarefulaction". British Medical Journal 331 (2019).
  28. Guung G. “Challenges and issues of free Healthcare policy in Nepal”. West African Journal of Medicine 1 (2020): 48-49.
  29. “Nigeria Health Review”. Health Reform Foundation of Nigeria, Kenbim press Ltd, Ibadan (2020).
  30. Hsiao W and Shaw RP. “Why Africa needs a new approach to financing health services for the poor”. World Bank, South Africa (2018).
  31. Kutzin J. “Health insurance for the formal sector in Africa”. WHO (2020).
  32. Lowel DH., et al. “Poverty and access to health care in developing countries”. Annals of the New York Academy of Sciences 1136 (2018): 161-171.
  33. Muntaz JE. “Reassessing catastrophic healthcare payments with a Nigerian case study”. Health Economics, Policy and Law3 (2018):309-326.
  34. O’Laughin O., et al. “Analyzing survey data. World Bank. (2018).
  35. Onotai LO and NC Nwankwo. “A review of the Nigerian healthcare funding system and how it compares to that of South Africa, Europe and America”. The Journal of Medical Sciences (2019).
  36. Onwujekwe OE and Uzochukwu BA. “Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in Southeast Nigeria”. BMC Research (2020).
  37. Onwujekwe OE., et al. “Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in Southeast Nigeria”. BMC Health Services Research (2020).
  38. Palmer N., et al. “Health financing to promote access in low-income settings”. How much do we know?” Lancet9442 (2020): 1365-1370.
  39. Sambo M. “Community health financing in Nigeria. Nigeria as an illustration, Nigeria’s flagship course on health sector reform and sustainable financing”. Federal Ministry of Health and World Bank Indicators (2021).
  40. Akinkugbe B. “Meeting the challenges of human capital development in Nigeria”. The case for reforms in our educational policies and system. A paper presented by CMO of MTNat the Alumni Convocation Lecture of the University of Nigeria, Nsukka (2019).
  41. Hoare G. “Policies for financing the Health sector. (2nd ). Health Policy and Planning Human development report on fighting climate change. (2018). UNDP (2019).
  42. Lambo E. “Making good health is a real dividend of democracy for Nigeria”. FMOH (2018).


Citation: Ajobiewe JO., et al. “National Health Insurance Scheme: Effect of Out-of-Pocket Payment and Access to Health Services. A Case Study of Federal Medical Center, FMC, Jabi, Abuja".Acta Scientific Microbiology 7.2 (2024): 133-149.


Copyright: © 2024 Ajobiewe JO., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate30%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 10, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US