National Health Insurance Scheme in Nigeria: Exploring Limitations to Utilisation by Adult Enrollees

AbstractDespite the introduction of the National Health Insurance Scheme aimed at ensuring easy access and affordable healthcare services to Nigerians, evidence abounds that most enrollees still find it difficult to access healthcare because of some factors militating against the smooth and easy access to the scheme. As a result, many people continue to die of preventable diseases as they cannot afford the catastrophic medical bills outside the National Health Insurance Scheme, while those who can afford the out-of-pocket medical expenses spend most of their budgets on healthcare services. This phenomenological qualitative study examined some factors limiting access to utilization of National Health Insurance Scheme by adult enrollees in Nigeria. Thirty participants including 10 inpatients, 17 outpatients, and 3 staff from implementing agencies of the National Health Insurance Scheme, were purposively selected for the study. Data were collected using in-depth interviews and analyzed thematically with the use of NVivo12. Findings revealed that delays in generating the secondary billing code, requests for airtime from patients, and language barriers, amongst others, are some of the factors affecting the utilization of National Health Insurance Scheme. The study recommended that the recruitment of more staff including social workers and abolishing the request for airtime from patients will improve utilization of healthcare through National Health Insurance Scheme. Future research may unravel the factors that lead to the request for airtime from enrollees and how it affects their utilization of National Health Insurance Scheme.Keywords: Adult enrolleesexperiencenational health insurance schemeutilizationsocial workerNigeria Disclosure StatementThere was no potential conflict of interest reported by any of the authors.