Health insurance is essential for ensuring that everyone has access to a whole variety of high-quality healthcare services without facing financial hardship. It includes the complete range of crucial health services, including health promotion, prevention, treatment, rehabilitation, and palliative care across the life course1. The delivery of these services requires healthcare professionals with an optimal skills mix at all levels of the health system, who are equitably distributed, and adequately supported with access to required working resources. When individuals have health coverage, they are more likely to seek medical attention when needed, receive timely treatments, and have better management of their health conditions. Additionally, it reduces the likelihood that people would be forced into poverty because of an unexpected illness2.
Achieving UHC is one of the targets of the 2030 Sustainable Development Goals (SDGs) in 2015. At the United Nations General Assembly High-Level Meeting on UHC in 2019, countries reaffirmed that health is a precondition and an indicator of the social, economic, and environmental dimensions of sustainable development. By 2025, 1 billion more people are expected to take advantage of UHC to benefit from more significant health and well-being1.
Recognizing the Impact of Health Insurance on the Health Systems
Health insurance serves as an alternative health funding method that might mitigate the negative impacts of external access to healthcare, particularly for the poor4,5. It is a viable way to achieve universal healthcare coverage. Additionally, it facilitates better access to prenatal care, skilled birth attendants, and postnatal care for pregnant women and newborns, all of which can lower the rates of maternal and child mortality.
Additional significant impacts of health insurance include the following:
- Building Health Systems
The availability of health insurance may result in increased demand for healthcare services, which, may drive the need for improved healthcare infrastructure and workforce. Strengthening healthcare systems, improving the capacity of medical institutions, and raising the standard of care can all be driven by health insurance.
- Reducing Health Inequalities
By ensuring that everyone has access to healthcare services, regardless of socioeconomic level, health insurance can help to reduce health inequalities. It makes healthcare more equitable doe all in society.
- Health Insurance Programs
The Government and policymakers play a critical role to develop and sustain efficient health insurance plans that meet the unique health requirements of the people. Many West African countries have used community-based health insurance schemes or social schemes to achieve successful health insurance coverage6. The National Health Insurance Authority (NHIA), Health Maintenance Organizations (HMO), and Healthcare Providers7 are the leading insurance stakeholder operators in Nigeria, and each of them makes a unique contribution to the health outcome. These stakeholders’ main goal is to guarantee UHC, which could facilitate greater access to healthcare services and lead to improved population health outcomes.
Overall, there are several related and positive effects of health insurance on the public health system. By encouraging access to care, facilitating preventative services, contributing to the gathering of health data, and encouraging cooperation between healthcare stakeholders and public health authorities, health insurance promotes public health initiatives. Countries may develop more thorough and efficient healthcare systems that put the health and well-being of their citizens first through realizing and utilizing the potential of health insurance in public health.
- World Health Organization. Social health insurance: sustainable health financing, universal coverage and social health insurance, 2005. Geneva: World Health Organisation WHO; 2005.
- World Health Organization 2023. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
- Spaan E, Mathijssen J, Tromp N, Mcbain F, Have A, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ. 2012;90(9):685–92. 7.
- Ezeoke OP, Onwujekwe OE, Uzochukwu BS. Towards universal coverage: examining costs of illness, payment, and coping strategies to different population groups in southeast Nigeria. Am J Trop Med Hyg. 2012;86(1):52–7. 8.
- Mcintyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, Ally M, Aikins M, Mulligan JA, Goudge J. Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania. Bull World Health Organ. 2008;86(11):871–6.
- Wang W, Temsah G, Mallick L. Health insurance coverage and its impact on maternal health care utilization in low- and middle-income countries. 2014 Sep 1 [cited 2019 Oct 22]; Available from: https://dhsprogram.com/publica tions/publication-as45-analytical-studies.cfm.
- National Health Insurance Scheme Operational. NHIS Operational Guidelines (Revised). 2012b. Available from:https://www.nhis.gov.ng/file/repository/ NHIS_Operational_Guidelines.pdf Accessed 12 Dec 2016