Access to and utilization of the National Health Insurance Scheme among older adults attending geriatric clinics in tertiary hospitals in Abuja, Nigeria: a descriptive cross-sectional study
This descriptive cross-sectional study of older adults in Abuja, Nigeria, reveals that while awareness, enrolment, and utilization of the National Health Insurance Scheme are relatively high in tertiary geriatric clinics, socioeconomic disadvantages and structural barriers such as long waiting times, drug unavailability, and restricted service coverage significantly hinder equitable access and sustained use.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine the human body as a bustling city that, over time, starts to need more repairs. As people get older, their "city" faces more traffic jams, broken pipes, and power outages, meaning they need to visit the repair shop (the hospital) much more often. In many places, these visits cost a fortune, and paying for them one by one can drain a family's savings, leaving them with nothing. To stop this, some countries set up a giant "community savings pot" called a National Health Insurance Scheme. Think of it like a group buy: everyone chips in a little money while they are working, so when they get sick or need help, the pot pays the bill instead of the individual. The big question for scientists is: Does this pot actually work for the elderly? Are they aware it exists, can they easily dip their hands in, and are they actually using it to fix their city's problems, or is the pot locked behind a wall of red tape?
This study dives into that very question in Abuja, Nigeria, by looking at a specific group of people: older adults (aged 65 and up) who are already visiting special "geriatric clinics" at two major hospitals. The researchers wanted to see if these seniors knew about the National Health Insurance Scheme (NHIS), if they were signed up for it, and if they were actually using it to get their medicine and check-ups. They treated the situation like a detective story, interviewing 111 seniors to find out what was working and what was blocking the path.
Here is what the investigation revealed:
The Good News: They Know and They Join
The study found that most of the seniors in these Abuja clinics were in the loop. About 83% of them knew the NHIS existed, and roughly two-thirds (67%) had some form of health insurance. Even better, about 67% were currently enrolled in the NHIS, and 66% were actively using it to pay for their care. This is much higher than the national average for the whole country, but the researchers note this is likely because these specific clinics are in the capital city and serve people who are generally wealthier and more educated than the average Nigerian.
When they did use the insurance, they mostly used it for the basics: seeing a doctor (99%), getting medicine (93%), and having simple tests done (90%). However, the "big ticket" items were rarely touched. Very few used the insurance for staying in the hospital overnight (15%), major surgery (14%), or advanced imaging like MRIs (only 3%). It's as if they had a key to a treasure chest, but the chest only held small coins, not the gold bars they really needed.
The Bad News: The Roadblocks
Even though many seniors had the key (enrollment), the door was often stuck. The researchers found a mountain of barriers that made using the scheme a headache. The biggest hurdles weren't about not knowing the scheme existed, but about how hard it was to use:
- The Wait: 87% of users complained about long waiting times.
- The Missing Items: 84% said the specific services they needed weren't covered by the plan.
- The Empty Shelves: 62% found that the drugs they needed were often unavailable.
- The Attitude: 58% felt the staff treated them poorly.
- The Distance: 81% said the registration centers were just too far away.
Who Gets Left Behind?
The study used math to figure out who was most likely to not use the insurance, even if they wanted to. The results were clear: if you had no formal education, were retired without a pension, or earned less than ₦100,000 a month, you were significantly more likely to be shut out. Being a retiree without a pension was a huge risk factor; these individuals were much more likely to be non-users compared to those with a steady pension. Essentially, the system worked best for those who were already financially stable and educated, leaving the poorest and least educated seniors struggling to get the protection they needed.
The Verdict
The researchers conclude that while the NHIS is a great idea and works well for some seniors in the city, it isn't quite ready for everyone yet. The "savings pot" is there, but the path to it is too long, the rules are too confusing, and the benefits don't cover the most expensive repairs. To fix this, the study suggests that the government should make insurance free for older adults (so money isn't a barrier), move registration offices closer to people's homes, and expand the list of covered services to include those expensive surgeries and hospital stays. Until then, for many older Nigerians, the insurance scheme remains a promise that is hard to keep.
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