WILLINGNESS TO ENROL AND PAY FOR A CONTRIBUTORY HEALTH INSURANCE SCHEME AND ITS DETERMINANTS: A SURVEY OF RURAL AND URBAN HOUSEHOLDS IN RIVERS STATE, NIGERIA.

Introduction/background: Health insurance schemes make healthcare more accessible and affordable, and are essential for protecting individuals and families from the financial risks associated with medical expenses.

Objectives: This study assessed the willingness to enrol and pay for a contributory health insurance scheme and its determinants among rural and urban households in Rivers State.

Methods: Cross-sectional study, with multistage sampling to survey 1196 households across 9 Local Government Areas, 3 from each Senatorial district. Data was collected using electronic questionnaires and analysed using SPSS version 27. Approval was from the Rivers State Research Ethics Committee.

Results: Among the households, 286 (24%) resided in urban and 910 (76%) in rural areas. The average age of respondents in urban and rural areas was 45.71 ± 14.90 years and 42.53 ± 16.02 years respectively (p = 0.003). Only 121 (42.3%) of urban and 177 (19.5%) of rural households were aware of a contributory health scheme (p < 0.001). Willingness to pay was similar in urban (40.5%) and rural (37.7%) areas but 93 (87.7%) of urban and 251 (84.8%) of rural household heads were not willing to pay above 5000 naira (p=0.761). Age determined willingness to enrol in urban areas, while age, sex, and occupation were determinants in rural areas (p < 0.05).

Conclusions: There was low awareness, moderate willingness to enrol, and reluctance to pay premiums above 5,000 Naira. Age, sex, and occupation were determinants of willingness to enrol. Strengthening community engagement could improve health insurance uptake and universal health coverage in the State. Keywords: Willingness to enrol, willingness to pay, Health Insurance, Universal health coverage, Rivers State.