1.1 Introduction
The national health insurance scheme (NHIS) functions as a social health insurance program designed by the federal government of Nigeria to improve every services related to financial health sector, and to improve access of health care for the majority of Nigeria. The evolution of the National Health Insurance scheme details back to 1962, when the need for health insurance in the provision of health care to Nigeria citizen was first announced. Furthermore, the introduction of the structural adjustment program in 1986 adversely affected health allocation and other factors that led to the introduction of the national health insurance scheme. This general poor stated of the nation’s health care services is giving the government a lot of concern.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
In the developed world, insurance in one form or the other is a veritable and sustainable tool for financing healthcare. The National Health Insurance (NHIS) was launched in Nigerian on October 15, 1997 and was passed into law in May 1999. The original scheme has been modified to include healthcare for less privileged persons in the country (FMH, 1998). Unfortunately it was truncated in 1985, Dr. Emmanuel Usman, the minister of health set up a committee on national health review led by Mr. L. Ligailu. At its 42nd meeting, the national council on health (NCH) approved the NIS to ensure full private sector participation. This model ensured the introduction of health maintenance organization (HMO) and financial managers of the scheme. On October 15th the national health insurance scheme was finally launched.
According to the World Health Organization (WHO) in 2005, Nigeria was ranked 197th out of 2000 nations; life expectancy was put at 48 years for male and 50 years for female while healthy life expectancy (HALE) for both sexes was put at 42 years. Nigeria accounts for 10% of global maternal mortality with 59,000 women dying annually from pregnancy and child birth; only 39% are delivered by skilled health professionals.
In order to provide equitable distribution of health, the NHIS was introduced in Nigeria. The need for the establishment of the scheme was informed by the general poor state of the nation’s healthcare services, excessive dependence and pressure on the government’s provision of health facilities, dwindling funding of health care in the face of rising cost, poor integration of private health facilities in the nation’s healthcare delivery system and overwhelming dependence on out-of-pocket expenses to purchase health. The concept of social health insurance was first mooted in 1962 by Heuvi committee, which passed the proposal through the Lagos health bill. This study evaluates one of the cardinal objectives of good governance which is to have effective healthcare delivery system put in place for the entire citizens. A healthy nation is a wealthy nation because of the absence of debilitating diseases and epidemics in such a country, which, along with hunger and squalor, impoverishes the citizenry (Nwatu, 2000:12).
It is also the government’s belief that NHIS will help to break the vicious cycle of poverty in the country. It is also a form of social support for workers (Jutting, 2003). Like any other insurance scheme, the premium for the NHIS is the amount charged by the insurance compared with the promise to pay for any eventual “covered medical treatment” for the designated “coverage”. Consequently health insurance makes it possible to substitute a small but certain cost for a larger but uncertain loss (chain) under an arrangement in which the healthy majority compensate for the risks and costs of the unfortunate ill minority. The NHIS currently represents 15% of one’s basic salary.
The employer is to pay 10% while the employee contributes 5% of his/her basic salary to enjoy healthcare benefits. The contribution made by the insured person entitles his/her spouse and four children under the age of 18 to full health benefits (FMH 2005). NHIS was designed to provide minimum economic security for workers with regard to unfavorable losses resulting from accidental injury, sickness, old age unemployment and premature death of family wage earner. NHIS is made compulsory because the government based on past experiences predicted that some citizens cannot engage in the scheme and the government also has the duty to protect the general welfare of all citizens (Ibiwoye and Adedeke, 2007).
Nurses have been launching businesses for many years starting with private duty nursing at the turn of the 20th century which was later replaced by institutional nursing after WWII (ICN, 2004). Private-duty nursing was the main form of work for nurses during the first 50 years of the profession and in many ways was the precursor to nurse entrepreneurship as it is today (Shirey, 2015).
The empowerment, entrepreneurial skill, and control over professional practice that was exhibited by the early 20th century private-duty nurse can still provide an example for today’s nurses (Whelen, 2012). Nurses in the 21st century are more educated, valued, and respected than ever before which positions them well to advance the profession through entrepreneurial endeavors (Shirey, 2015).
During times of economic uncertainty, knowledge about entrepreneurship and entrepreneurial skills can be exploited when health care staff needs to figure out how to do more with fewer resources (Boore and Porter, 2010). Some studies indicate that a lack of competence in entrepreneurship is a major barrier for nurses who want to become entrepreneurs (Drennan,Davis, Goodman, 2007). Nurse entrepreneurs claim that when their education is based on the traditional forms of nursing, it does not provide them with enough knowledge about entrepreneurship or establishing and running a company (Elango,Hunterand Winchell 2007).
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to examine the Perception and Challenges of Nurses towards Health Insurance Scheme.
1.3 Statement of Problems
Investigation revealed that in Nigeria, health insurance scheme is new; the target of its introduction is to achieve good health to all citizens in Nigeria. Most of Nigeria are unemployed, resident in the rural areas without hospital, water and infrastructure and inadequate personnel.
There is lack of health care coverage and little equity. Access to healthcare is limited and most Nigerians are unable to pay for health services and health facilities are far from being equitably distributed. All these contributed to the limitation in health services (Samin and Awe, 2009). The available health services are very expensive and the common man cannot afford it; only the privileged few can get access to good health. This study aims at assessing the level of knowledge and attitude of civil servants resident in Nigeria to NHIS.
1.4 Aim and Objectives of Study
The aim of the study is to examine the Perception and Challenges of Nurses towards Health Insurance Scheme in Irrua Specialist Teaching Hospital. In achieving this aim, the following specific objectives were laid out as follows:
- To examine the perception Nurses towards Health Insurance Scheme sensitization;
- To evaluate the problems of health insurance scheme affecting Nurses in Nigeria;
- To examine the goals and roles of the operators of the scheme;
- To identify the perceived barriers regarding entrepreneur in nursing; and
- To investigate the various methods used in marketing health insurance service among Nurses in Nigeria.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the perception Nurses towards Health Insurance Scheme sensitization?
- What is the perception Nurses towards Health Insurance Scheme sensitization?
- What are the goals and roles of the operators of the scheme?
- What are the perceived barriers regarding entrepreneur in nursing?
- What are the various methods used in marketing health insurance service among Nurses in Nigeria?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There are no significant problems of health insurance scheme affecting Nurses in Irrua Specialist Teaching Hospital
- H1: There are significant problems of health insurance scheme affecting Nurses in Irrua Specialist Teaching Hospital
Hypothesis Two
- H0: There is no significant relationship between the health insurance scheme and Nursing in Irrua Specialist Teaching Hospital.
- H1: There is a significant relationship between the health insurance scheme and Nursing in Irrua Specialist Teaching Hospital.
1.7 Significance of Study
It is believed that at the completion of the study, the findings will be of benefit to the; Federal Ministry of Health, National Health Insurance Scheme Council (NHISC) to identify all the constraints to effective implementation of the scheme. The regulatory aspect of these challenges will be established in this study so that the NHISC will take remedial measures. To the Health Maintenance Organization (HMOs) as it will not only highlight the challenges facing them under the scheme but will also provide useful information on how they can effectively address these challenges especially those arising from their internal constituencies.
To the Health Services Providers (HSPs),as those already operating under the scheme will be provided with useful information on how to brace up with their challenges while those not yet operating under the scheme will find in this study the need to be integrated into the national healthcare delivery system via the NHIS. To the government as the recommendations in this study will also be useful for its policy review in respect of the scheme.
This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.8 Scope of Study
The scope of this research is focused on the Perception and Challenges of Nurses towards Health Insurance Scheme using Irrua Specialist Teaching Hospital in Edo State as a case study.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Definition of Terms
Evaluation: the making of a judgment about the amount, number, or value of something; assessment.
Health: Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage.
Insurance: Insurance is a means of protection from financial loss. It is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss.
Health Insurance: Health insurance is a type of insurance coverage that covers the cost of an insured individual’s medical and surgical expenses depending on the type of health.
The National Health Insurance Scheme (NHIS): Is a body corporate established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost through various prepayment systems.
