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Health Insurance and Economic Development in Nigeria

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Abstract

In Nigeria, health Insurance has been identified as a risk transfer mechanism used primarily to hedge against an unforeseen contingency. Recently debates have revolved around extending health insurance coverage to a wider range of the population as this will ensure growth in the socioeconomic productivity in Nigeria. This study therefore examined the nexus between health insurance and socioeconomic productivity in Nigeria using descriptive research method. Findings from the study showed that there is a significant relationship between private health insurance and socioeconomic productivity. This implies that enrolees on healthcare insurance services are more productive as the out-of-pocket payment for healthcare services tend to be far lower than individuals without healthcare insurance services. The study also revealed that there is a significant relationship between hospital reimbursement benefit and economic development in Nigeria. Lastly the study revealed that accident insurance has a significant effect on economic development in Nigeria. Based on these findings the study recommends that the National Health Insurance Scheme (NHIS) should expand coverage to more persons in the rural and urban centres: while incentives should be provided to promote not-for-profit and community-based insurance schemes. It was also recommended that there is need for the introduction and enforcement of Hospital Reimbursement Benefit through public-private partnership. Finally, the study recommends that the government need to create strong awareness for the benefit of Accident insurance in order to protect the people against sudden eventualities.
1
Health Insurance and Economic Development in Nigeria
AGUM CHARLES
Department of Economics,
Nasarawa State University, Keffi,
Nasarawa State. Nigeria.
agumcharles@gmail.com
Abstract
In Nigeria, health Insurance has been identified as a risk transfer mechanism used primarily
to hedge against an unforeseen contingency. Recently debates have revolved around extending
health insurance coverage to a wider range of the population as this will ensure growth in the
socioeconomic productivity in Nigeria. This study therefore examined the nexus between health
insurance and socioeconomic productivity in Nigeria using descriptive research method.
Findings from the study showed that there is a significant relationship between private health
insurance and socioeconomic productivity. This implies that enrolees on healthcare insurance
services are more productive as the out-of-pocket payment for healthcare services tend to be
far lower than individuals without healthcare insurance services. The study also revealed that
there is a significant relationship between hospital reimbursement benefit and economic
development in Nigeria. Lastly the study revealed that accident insurance has a significant
effect on economic development in Nigeria. Based on these findings the study recommends that
the National Health Insurance Scheme (NHIS) should expand coverage to more persons in the
rural and urban centres: while incentives should be provided to promote not for profit and
community- based insurance schemes. It was also recommended that there is need for the
introduction and enforcement of Hospital Reimbursement Benefit through public-private
partnership. Finally, the study recommends that the government need to create strong
awareness for the benefit of Accident insurance in order to protect the people against sudden
eventualities.
Keywords: Socio-economic productivity, Health Insurance, Accident Insurance
I. Introduction
Of developing countries, the inability to meet the health care needs and services of their poor
population has posed a major challenge to the development. The poor allocation of financial
resources to meet these needs has further dampen the public effort in alleviating the people out
of this quaquire. Hence, the application of user cost to funding health care services (World
Bank, 2014) This has engendered insurance programme to supplement and facilitate access to
health services in most economies. Insurance has been identified as a risk transfer mechanism
2
used primarily to hedge against an unforeseen contingency. It has been adjudged to be a social
scheme which provides financial indemnity for the effects of a misfortune. The indemnity is
provided from the pool of accumulated contributions of all members participating in the
scheme (Isimoya, 2007). Indeed, insurance is concerned with risk, and it offers financial
indemnity to those who suffer the effects of loss (Bob-Alli, 2010).
Healthcare delivery services have been unevenly provided across countries. In these
economies, a large proportion of health seekers are uninsured and could hardly purchase their
healthcare from a subsidized public sector, while a smaller proportion purchase their healthcare
from a highly developed private sector, where purchases are often, at least partially covered
by a third-party insurance contract. For those who are uninsured, efforts to obtain healthcare
will create out of pocket expenditures, and this affects their ability to purchase other items.
Uninsured health person may need to draw down their savings, sell assets or substitute away
from other household goods.
There are several possible ways to classify health insurance schemes either introduced by
health facilities, members based organizations, local communities or cooperatives, according
to, kind of benefits provided, degree of risk pooling, circumstances of their creation, fund
ownership and management and the distinction whether the schemes focus on coverage for
high-cost, low frequency events or on low cost, high frequency events. Similar characteristics
of these schemes are; voluntary membership, non-profit character, prepayment of contribution
in to a fund and entitlement to specified benefits, important role of the community in the design
and running of the scheme and institutional relationship to one or several health care providers
(Jutting, 2003).
The changing lifestyles, high level of competition and environmental pollution have engender
various health related problems. One of the major concerns facing families in Nigeria thus
3
relates to health care. Health care it is not only expensive but is also time consuming and
physically demanding for family health care givers. Nigeria is faced with continued severe
economic and social crises which make many households to no longer afford the basic
necessities of life for their members. The ability of households to cope with adverse economic
conditions has been stained. Difficult trade-offs continue to be made in an attempt to keep
households afloat.
These social upheavals have led to breakdown in the health of individuals, households and
communities. Based on these, this study intends to examine the nexus between Health
Insurance and economic development in Nigeria.
In the course of this study, the following research questions are posed to validate data for the
findings viz:
i. What is the relationship between Private Health Insurance plans and economic
development in Nigeria?
ii. What effect does Hospital Reimbursement Benefits have on economic development in
Nigeria?
iii. How has accident Insurance contributed to economic development in Nigeria?
Based on the research questions posed, the following hypotheses are stated to determine the
findings viz:
H01: there is no significant relationship between Private Health Insurance plans and economic
development in Nigeria
H02: Hospital Reimbursement Benefit has no significant effect on economic development in
Nigeria
H03: Accident Insurance has no significant effect on economic development in Nigeria
II. Conceptual Clarification
4
According to Andersen (2005) the practice of pooling resources to ensure protection against
the risks of ill-health grew mainly out of labour developments, in Medieval Europe, craftsmen
formed societies (“guilds”), which in turn created funds to help members in times of distress,
due to sickness. Each member contributed to the fund on a regular basis. The threat to the
individual worker's earnings because of illness was seen as a risk to be shared, and from the
late eighteenth and early nineteenth century’s groups of workers and small farmers in the same
industry or location formed sickness funds as mutual benefit societies to serve this purpose.
First cash benefits were provided, and then the guilds asked doctors to certify sickness.
Health Insurance is a system of advance financing of medical expenses through contribution,
premium paid into a common fund to pay for all and part of health services specified in an
insurance policy or plan (Oriakhi, and Onemolease, 2012). Insurance has also been defined as
a social scheme which provides financial indemnity for the effects of a misfortune. Insurance
is concerned with risk, and risk is associated with all human endeavours. Therefore, risk is
defined as uncertainty of loss. Bob-Alli (2010) stressed that insurance was designed to
eliminate the uncertainty of loss which is with us every day. She went ahead to state that what
insurance does is to offer financial indemnity to those who suffer the effects of loss and peace
of mind for the fortunate member of the pool. The term health insurance is basically used to
describe that form of insurance which pays for almost all medical expenses. It is many times
used much more broadly to include insurance covering long term nursing or disability care
needs (Quaye, 1991). It is a mechanism in which the risk of incurring health care costs is
spread over a group of individuals or households (Arhin Tenkorang, 2001). It may be
provided through a private insurance company, agency or provider or from a government
sponsored social insurance programme. It may also be on a group basis like a company to cover
its employees or bought by individual consumers.
The National Health Insurance Scheme (NHIS); A Brief Background
5
In order to improve access to quality health care services and health status of the citizens, the
National Health Insurance Scheme was 2005. The NHIS is a public-private-partnership
between the NHIS, the Health Maintenance Organizations (HMOs) and other health care
providers (private and public). The overall objective is to secure universal health coverage and
access to adequate and affordable health care, in order to improve the health status of the
citizens. It had the mandate to achieve this (UHC) within a period of ten years from its inception
(2005-2015). While the NHIS shapes the health insurance policy by licensing the HMOs that
operates the health insurance business, it also accredits health care facilities to provide the
benefit packages to registered enrollees. The HMOs are responsible for the purchase of health
care services on behalf of the Scheme for registered enrollees. Currently, there are 62 HMOs
contracted by the NHIS to function under the Scheme. However, of these HMOs, only 5 have
a total of 75% of the current enrollees. Under the present arrangement, an individual federal
government worker is entitled to register a spouse and four children under the age of 18 years.
Enrollees choose their preferred health facility to receive care (Federal Ministry of Health
2014).
To ensure an effective coverage of the populace, the Scheme has specific programmes for
different segments of the society. Some of the Formal Sector Health Insurance Programme for
the Federal Civil servants, Urban Self-employed Social Health Insurance Programme, Rural
Community Social Health Insurance Program, Children under Five Social Health Insurance
Programme also covers pregnant women (Federal Ministry of Health 2016).
Of the 23,640 health care facilities available in the Country, only 7,300 representing
31% of the facilities were accredited by the NHIS to provide services to registered enrollees.
Currently, 4.5million people representing 3% of Nigeria’s population are covered under the
Scheme. This percentage is mainly in the formal sector. The remaining 75% or more, in the
informal sector are largely not covered yet. Under the present arrangement, the employer
6
contributes 10% of the basic salary of the insured while the remaining 5% is paid by the
employee.
Theoretical Framework
Healthcare Demand theory
Among theories and empirical studies on the demand function for healthcare which highlights
the relationship between health, healthcare and economic growth. The Demand for healthcare
services is described within static utility-maximizing framework, pioneered by Grossman
(1972). In this framework, individuals are assumed to consume healthcare not because they
value healthcare per se, but because it improves their stock of health, which is used as a
productive resource. Cropper (1977) extended Grossman’s model to the disutility that illness
may impose on individuals, and examine differences in the demand for preventive and curative
care, and the dynamics of demand for healthcare over the life cycle.
Healthcare is fundamentally a production process and shares many of its economic concepts
with production generally. Several studies offer insights into the contribution of healthcare to
health. Evidence suggests that lifestyle and environment expenditure could provide more
marginal benefits per dollar cost of health than healthcare. Especially healthcare is seen as a
major contributor to health. Economists and policymakers are so much concern about the price
and income elasticities of the demand for healthcare. This is because; they determine the effects
of various pricing and distributional policies on healthcare demand. If there is no
responsiveness of demand to price, then prices play little role in determining the allocation of
healthcare resources among individuals. In the absence of financing constraints, free provision
of healthcare might be required. But healthcare is responsive to price, some user fees should
probably be charged to discourage application. These charges should however, not be so high
as to force individuals into imprudent decisions about whether to seek medical attention.
7
Similarly, if income has a large, with direct effect on demand or on the price responsiveness of
demand, some form of targeting of subsidized healthcare services may be desirable.
Empirical Review
Improving the health sector has become a major topic of discourse among health economists.
However, relatively little attention has been placed on the relationship between health, health
outcomes and economic development in Nigeria. Ichoku (2009) utilized the Aronson, Johnson,
and Lambert (1994) decomposition framework to analyze the redistributive effects of
healthcare financing in terms of vertical and horizontal inequities in Nigeria. While this study
is commended for espousing the high incidence of catastrophic health care financing,
impoverishment, and inequities, that are both vertical and horizontal in Nigeria, the study limits
itself to considering only household income as the major determinant of healthcare spending.
Investigating the relationship between health insurance and development by Baldacci (2004)
using a panel data set for one hundred and twenty developing countries form 1975-2000. He
observed that health insurance programmes within the period affect economic development
within the same period while lagged health expenditures appear to have no effect on growth.
He inferred from this result that the direct effect of health insurance on growth is a flow and
not a stock effect. Studies by such Greiner (2005), Strauss and Martins (2005) and Agenor
(2007), in other countries affirm that health insurance is positively related to economic
productivity. even differs where this from one country to another on level the extent and
contributions to its development
Using non-parametric techniques and Malmquist productivity indices, Miika (1995) compared
various model specifications in analyzing the development of insurance schemes towards
productivity in Finland during a transition period towards quasi-markets ‘in health care. Her
findings revealed that the state subsidy reform initiated by the government in 1993 towards the
8
provision of insurance packages accelerated the expansion of the production possibilities
frontier. This is premised higher on technical change of hospitals during 1992 and 1994. It
further demonstrates that progress in productivity was mostly due to the exogenous rate of
technical change.
The Malmquist indices utilized clearly revealed that there was an average annual productivity
increase of 3-4%, largely attributable to the contribution of insurance schemes in the state.
Hence, since productivity has already been improved well before the subsidy reform of 1993,
economic depression that ensued might have had a marked additional impact on hospital
productivity growth (Miika, 1995). The finding equally revealed that state subsidy reform
affected hospital performance through other mechanisms, e.g. increased political pressure,
which was not monitored in the study.
A study by Ichoku et al (2009) had its findings revealed with a large incidence and severity of
catastrophic healthcare financing in Nigeria, and that a very high percentage (77%) of
healthcare financing in Nigeria is through OoP (Out of Pocket) payment. This implies that
individuals bear a greater brunt of ill health. Productive capacity is affected by ill health and
the inability to pay for health care services delays recovery and increases absenteeism, which
also affect productivity.
Evidence abound that health has a major impact on the raising of labour productivity in general.
Studies by Bloom, Canning and Sevilla revealed that a single percentage increase in adult
survival rate as a result of increase in availability of health care services increased labour
productivity by as much as 2.8 percent; which signifies the importance of health financing
(Bloom, Canning and Sevilla, 2002) by the public sector
Samba (2010) studied the efficiency of health systems in 45 Sub- Saharan African countries
between 2005 and 2011 adopting the stochastic frontier technique, a parametric approach.
Infant survival rate was adopted as a proxy for output while per capita health expenditure as
9
the indicator for input. Their findings reveal large disparity in efficiency across health systems
in the region. It also demostrate lack of efficiency in the utilization of resources at 20% of
resources are being wasted.
Chaabouni and Abednnadher (2010) examined the impact of health insurance expenditures in
Tunisia during the period 1961-2008, in an attempt to investigate the chain of causality using
the Autoregressive Distributed Lag (ARDL) approach by Pesaran (2001). While the results of
the bounds test showed that there is a stable long-run relationship between health Insurance
expenditure, population ageing and medical density; the results of the causality test showed
that there is a bi-directional causal flow from health Insurance expenditures to income, which
are both in the short and in the long run. They were of the newthat policies aiming at
encouraging health insurance are required to build up a healthier and productive society to
support the Tunisian’s economic growth and development.
III. Research Methodology
Research Design: For the purpose of this study, descriptive research design was used. This
design describes the phenomena as they exist. It was used to identify and obtain information
on the characteristics of a particular problem or issue. Descriptive research design was selected
because it has the advantage of producing good amount of responses from a wide range of
people. Also, this design provides a meaningful and accurate picture of the relationship
between health insurance and socio-economic productivity. This research design would also
clearly explain the perception about health insurance and how it contributes towards
productivity on the basis of the data collected. The advantage with this design is that it helped
the paper to obtain views as they are in their natural setting.
Population and Sample Techniques: The population of the study covers purposively selected
health insurance firms operating in Nigeria.
10
Stratified sampling was primarily used to ensure that different groups of the population are
adequately represented in the sample so as to increase the population’s level of accuracy when
estimating the parameters. The strata are made up of four health insurance firms. The strata are
formed based on members' that shared similar attributes or characteristics. A sample from each
stratum is taken in a number that is proportional to its size when compared to the population.
These subsets of the strata are then pooled to form the sample. The above reasons formed the
basis for the use of stratified sampling for this paper.
Table 1: Population Selected Health Insurance Firms in Nigeria
S/N
Health Insurance firms
Population
1
Premium Health
131
2
Mediplan Health
81
3
Healthcare security
231
4
Integrated Healthcare
115
Total
558
Source: Field Survey, 2020
Sample Technique
Smith (1984) sample technique was used to estimate a sample size out of the study population.
The Smith (1984) formula is given by:
2
3N
nNe
=+
Where:
N = Population size
3 = Constant
e = Margin of error (5%)
2
3N
nNe
=+
Substituting into the formula we have:
2
558
3 558(0.05)
n=+
558
3 558(0.0025)
n=+
n
= 126
11
Proportional allocation formula was applied to each stratum to ensure even-spread as captured
in Table 2. The proportionate formula used is given as:
N
nNh
nh=
Where;
nh = number allocated each class strata
n = Total sample
Nh = Total population of each strata
N = Total population
Table 2: Selected Health Insurance Firms in Nigeria
S/N
Health Insurance Firms
Population
Sample
1
Premium Health
131
126*131 30
558 =
2
Mediplan Health
81
126*81 18
558 =
3
Healthcare security
231
126*231 52
558 =
4
Integrated Healthcare
115
126*115 26
558 =
Total
558
126
Source: Field Survey, 2020
Instrument of Data Collection: Questionnaire was the instrument used in data collection and
was administered by the researcher to ensure high level of reliability. The respondents were
required to read each question carefully and indicate their agreement or disagreement with the
statement using various scaling units. Some responses were keyed using Likert scale ranging
from: strongly agree, agree, undecided, disagree, and strongly disagree etc.
Table 3: Result of Reliability Test
Variable
Alpha
Socio-economic productivity
0.7445
Private Health Insurance
0.6753
Hospital reimbursement Benefit
0.7783
Accident Insurance
0.6922
Test to scale
0.7987
Field Survey, 2020
12
From the table above it can be observed that the levels of alpha are well above the 0.60 typically
accepted level, demonstrating a high level of internal consistency. As shown in Table 3 the
alpha levels for the different indicators averaged alpha coefficient of 0.7987 is greater than
0.60, fully supporting the reliability of the constructs.
The data collected through the distributed questionnaire were subjected to analysis and testing
of the hypothesis using the Linear Regression with the aid of Statistical Package for Social
Science version 23 (SPSSv.23.0),
The regression model developed which was used to capture the independent variable is the
economic productivity and the independent variables for the study are Private health insurance,
Hospital Reimbursement benefits and accident insurance.
The model formulated to test the hypothesis is state below:
0 1 2 3 t
SP PI HRB AI
 
= + + + +
Where;
SP = economic development
PI = Private Insurance
HRB = Hospital Reimbursement Benefit
AI = Accident Insurance
t
= Error term
13

= Slope coefficients of
0
= Intercept parameter estimate for private insurance, hospital reimbursement
benefit and accident insurance.
IV. Discussion of Results
The three hypotheses formulated in this study were validated with the aid of P-value which is
observed from the regression result. The level of significance for the study is 5%, for a two-
tailed test.
13
If the probability (Sig) > 0.05 we accept the null hypothesis and reject the alternative
hypothesis.
If the probability (Sig) < 0.05 we accept the alternative hypothesis and reject the null
hypothesis.
Table 4: Regression Model Result: Dependent Variable- SP
Regression Output
Coefficients
t-Value
P-value
Std. Error
L-95%
U-95%
Intercept
0.2587
4.2201
0.023
0.1235
0.0813
0.3469
PI
0.1797
1.9849
0.003
0.0845
0.0845
0.2669
HRB
0.3569
2.4631
0.014
0.0782
0.1845
0.2669
AI
0.0951
1.9932
0.021
0.0597
0.0441
0.7456
Summary Statistics
Multiple R
0.7654
Durbin-Watson stat
1.5785
R-Square
0.6534
Standard Error
0.5009
Adjusted-R-Square
0.6043
Observations
126
ANOVA Output
Df
SS
MS
F*
P-value
Regression
6
34.2
18.15
12.11
0.0000
Residual
119
122.46
1.12
Total
126
223.19
Source: Researchers Computation, 2020
ANOVA Statistics
ANOVA Output (The F-statistic): The F-statistics which is used to examine the overall
significance of regression model showed that the result is significant, as indicated by the value
of the F-statistic, 12.11. That is, the F-statistic P-value of 0.0000 is less than 0.05 at 5% level
of significance.
Coefficient of Determination (
2
R
): The (R-square) value of 0.65 revealed that Health insurance
has a very good impact on economic productivity. It indicates that about 65.34per cent of the
variation in economic productivity is explained by health insurance, while the remaining
unaccounted variation of 35.56% is captured by the error term.
14
Auto-correlation: Durbin Watson (DW) statistic was used to test for the presence of serial
correlation or autocorrelation among the error term. The acceptable Durbin Watson range is
between 1.5 and 2.4. The model thus indicates that there is no autocorrelation among the
variables as indicated by Durbin Watson (DW) statistic of 1.57. This demonstrates that the
estimates are unbiased and can be relied upon for policy decisions.
Hypotheses One:
H01: there is no significant relationship between Private Health Insurance plans and economic
development in Nigeria
Table 4, presents the result from the regression analysis and it shows that that the calculated t-
value for private health insurance is 1.98 and with p- value of 0.003. Since the p-value is less
than 0.05 (0.003 < 0.05) it thus falls in the rejection region and hence, we reject the first null
hypothesis (H01). This therefore concludes that there is a significant relationship between
private health insurance and economic development in Nigeria.
Hypotheses Two:
H02: Hospital Reimbursement Benefit has no significant effect on economic development in
Nigeria
Furthermore, the regression results also revealed that the calculated t-value for Hospital
reimbursement benefits is 2.46 and with an associated p-value of 0.01 Since the p-value is less
than 0.05, we reject the second null hypothesis (H02). The conclusion therefore is that hospital
reimbursement benefit has a significant effect on economic development in Nigeria.
Hypotheses Three:
H03: Accident Insurance has no significant effect on economic development in Nigeria
Lastly, the calculated t-value Accident insurance was found to be 1.99 and also by rule of
thumb, the tabulated value is ±1.96 under 95% confidence interval levels. Since the p-value for
accident insurance was found to be less than 0.05 (that is; 0.02 < 0.05), we thus, reject the third
15
null hypotheses (H03). The study thus concludes that accident insurance has a significant effect
on the economic development in Nigeria.
Discussion of findings
The study revealed that health insurance has a significant relationship with economic
development in Nigeria. Findings from the study revealed that private health insurance has a
significant relationship with economic development in Nigeria. This study finding implies that
the buying of health insurance has significantly contributed to the development in Nigerian.
The study also revealed that hospital reimbursement benefit has a significant effect on
economic development in Nigeria. This study finding is particularly observed from the
regression out which revealed that the p-value is less than the 0.05 level of significance. The
Hospital reimbursement benefit ensures that individuals who are covered under this insurance
package and refunded their out-of-pocket expenditure for health cost. Lastly, it was observed
from the study that accident insurance has significant effect on the economic development in
Nigeria. This is particularly observed from the regression output which was presented from the
above table. The accident insurance ensures that individuals who are covered under this
insurance package are well protected in case of an accident. This study finding is similar to the
findings of Baldacci (2004) who investigated the effect of health insurance and development
using a panel data set for one hundred and twenty developing countries form 1975-2000. He
discovered that health insurance affects economic development. With the continuous
increasing cost of health services in Nigeria, health insurance provides indispensible
opportunity to get quality healthcare at a fair price hence increasing the economic development
in Nigeria.
V. Conclusion and Recommendations
This study was carried out to examine the link between health insurance and economic
development in Nigeria. The study revealed that health insurance contributes significantly to
16
economic development in Nigeria. The enrollee of health insurance benefits much more than
individuals who do not have any form of health insurance covers in Nigeria. The increasing
cost of healthcare services in Nigeria has made it mandatory for individuals to enroll on
insurance for better and cheaper healthcare services in Nigeria. The out-of-pocket payment for
healthcare services in Nigeria is far much heavy than individuals who are covered by one
healthcare insurance scheme or the other.
Based on the findings, the following recommendations are made:
i. The National Health Insurance Scheme (NHIS) should expand coverage to more
persons in the rural and urban centres: while incentives should be provided to promote
not for profit and community- based insurance schemes.
ii. There is need for the introduction and enforcement of Hospital Reimbursement Benefit
through public-private partnership
iii. The government need to create strong awareness for the benefit of Accident insurance
in order to protect the people against sudden eventualities.
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The study examined rural households' willingness to participate in Community Based Health Insurance (CHBI) scheme in Edo State, Nigeria. Factors that are likely to influence household participation in the scheme were specifically determined. A random sample of 360 families from the three senatorial zones of the state was taken. Their responses were analyzed using frequency tables and logistic regression. The findings revealed that 59.4% expressed willingness to participate in a community based insurance scheme. Important reasons for those not willing to participate in the scheme were lack of trust on scheme fund administrators (mean = 2.54) and government policies/programmes which are considered very unstable and unsustainable (2.53). Based on the Logistics regression results, key demographic factors found to be significant determinants of rural households willingness to participate in the insurance scheme include household size (b= 0.507) and membership of town association or union (b=0.564), while income (b = -0.410), medical expenses incurred (0.316) and credit (0.277) were important economic characteristics. The study recommended the incorporation of community participation in the scheme especially in scheme management selection and awareness creation as measures to promote CBHI programme in the state.
Article
Microeconomic analyses typically suggest that worker health makes an important contribution to productivity and wages. Weil (2001) uses estimates of the individual-level relationship between health and wages to calibrate an aggregate production function and suggests that differences in health are roughly as important as differences in education in explaining cross-country differences in gross domestic product per worker. We estimate the effect of health on worker productivity directly using cross-country macroeconomic data. We find a positive and significant effect. In addition, the estimated effect of health on aggregate output is consistent with the size of the effect found in microeconomic studies.
Article
The influence of history on an organization is a powerful but often overlooked force. Managers, in their haste to build companies, frequently fail to ask such critical developmental questions as, Where has our organization been? Where is it newt and What do the answers to these questions mean for where it is going? Instead, when confronted with problems, managers fix their gaze outward on the environment and toward the future, as if more precise market projections will provide the organization with a new identity. In this HER Classic, Larry Greiner identifies a series of developmental phases that companies tend to pass through as they grow. He distinguishes the phases by their dominant themes: creativity, direction, delegation, coordination, and collaboration. Each phase begins with a period of evolution, steady growth, and stability, and ends with a revolutionary period of organizational turmoil and change. The critical task for management in each revolutionary period is to find a new set of organizational practices that will become the basis for managing the next period of evolutionary growth. Those new practices eventually outlast their usefulness and lead to another period of revolution. Managers therefore experience the irony of seeing a major solution in one period become a major problem in a later period. Originally published in 1972, the article's argument and insights remain relevant to managers today. Accompanying the original article is a commentary by the author updating his earlier observations.
Article
This article presents the results of the comparative research project, "Managed Care in Latin America: Its Role in Health System Reform." Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations' intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms.
Maternal Mortality Situation and Determinants in Nigeria Abuja, Federal Ministry of Health
  • T Arhin
Arhin, T. (2001). Maternal Mortality Situation and Determinants in Nigeria Abuja, Federal Ministry of Health.
National Health Insurance Scheme and Employees Access to Health Care Services in Cross River State
  • A M Agenor
Agenor, A.M. (2007). National Health Insurance Scheme and Employees Access to Health Care Services in Cross River State, Nigeria Journal of Public Health 1(13):29-54
Revisiting the Behavioural Model and Access to Medical Care: Does it Matter?
  • R M Anderson
Anderson, R.M. (2005). Revisiting the Behavioural Model and Access to Medical Care: Does it Matter? Journal of Health and Social Behaviour, 36:1-10.
Fundamentals of Insurance Operations. Barmco Publishers Federal Ministry of Health (FMoH) (2014), Nigeria. Strategic Review of Nigeria's National Health Insurance Scheme
  • M Bob-Alli
Bob-Alli,M.M(2010). Fundamentals of Insurance Operations. Barmco Publishers Federal Ministry of Health (FMoH) (2014), Nigeria. Strategic Review of Nigeria's National Health Insurance Scheme. Abuja Nigeria; 2014.
Catastrophic healthcare financing and poverty: empirical evidence from Nigeria
  • H E Ichoku
  • W M Fonta
Ichoku, H. E. and Fonta W. M. (2009). "Catastrophic healthcare financing and poverty: empirical evidence from Nigeria.‖ Journal of Social and Economic Development. http://www.thefreelibrary.com/Catastrophic+healthcare+financing+and+poverty% 3A+empirical+evidence...-a0213956972