Systematic literature review and narrative synthesis of the effectiveness of health insurance in improving access to healthcare and providing financial protection in Nigeria.

BACKGROUND

This study conducted a systematic literature review with narrative synthesis to examine the effectiveness of health insurance in improving access to care and reducing out-of-pocket (OOP) health spending among beneficiaries.

METHODS

Using PRISMA guidelines, a systematic search was conducted across three databases (Web of Science, PubMed, and Google Scholar). Results were limited to human studies published in English between 2015 and 2024. Studies reporting on the effectiveness of health insurance were included and critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The findings were synthesised using a thematic narrative synthesis approach.

RESULTS

The database search identified 495 studies. After removing duplicates and completing title, abstract, and full-text screening, 12 studies were included in the review. From the results, it is suggestive that health insurance has the potential to increase healthcare uptake and reduce excessive dependence on OOP, and hence can guarantee financial protection. However, enrolment remains low and significant disparities exists in enrolment between rural and urban, northern and southern population and educated and non-educated class.

CONCLUSION

Efforts should be directed towards encouraging enrolment into health insurance, and improve its benefits for enrollees. However, to encourage enrolment, especially among the poor and rural population, Nigerian government should commit itself in full implementation the Vulnerable Group Fund which aims to target over 83 million Nigerians in the informal sector for coverage.