A quasi-experimental study on health insurance coverage and health services in Nigeria.

BACKGROUND: Nigeria has the highest maternal mortality rate among sub-Saharan African countries. Recently, universal health insurance coverage has been embraced as a means to enhance population health in low- and middle-income countries. Hitherto, the effect of health insurance coverage on the utilisation of facility-level delivery is largely unknown in the face of the earnest need to lower maternal mortality rates in developing countries. AIM: To empirically investigate the association of health insurance coverage on health services utilisation of facility-level delivery and the extent to which public- and private-sector facility delivery in Nigeria had a disproportionate associational effect with health insurance coverage, in the universal health coverage era. SETTING: A cross-sectional study conducted for Nigeria. METHODS: This study employed a quasi-experimental method using propensity scores along with different matching methods that were applied to the most recent wave of Nigeria's Demographic and Health Survey (2020) data. RESULTS: Evidence suggests that childbearing mothers from insured households had an average of 25% probability of utilising facility-level delivery relative to mothers from uninsured households in the year that preceded the survey. Moreover, private-sector facility delivery had a 31% higher associational effect with health insurance coverage than public-sector facility delivery, which had an estimated probability of 21%. CONCLUSION: Expansion of health insurance coverage in Nigeria will be a desirable way to stimulate the utilisation of facility-level delivery by women of childbearing age. Consequently, coverage expansion has the potential to save many maternal and newborn lives in Nigeria.Contribution: This study has contributed to the urgent attention of the federal government of Nigeria to monitor and revamp the health insurance coverage policies of the country for better facilitation of health services to the Nigerian population.

Application of DEA-Based Malmquist Productivity Index on Health Care System Efficiency of ASEAN Countries.

This study assesses and compares the productive efficiency of the national healthcare system of the ASEAN region which includes Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam amidst rising mortality rate from noncommunicable diseases (NCDs) in the Sustainable Development Goals (SDGs) era. Nonparametric data envelopment analysis technique based on the Malmquist Productivity Index is performed and its components, total factor productivity change, technical change and technological change are compared across the region. Two different models are considered in assessing and comparing the technical efficiency of the national healthcare system across the region with life expectancy at birth and mortality rate from NCDs as parallel health care output for both the models. The mean value of total factor productivity is 0.983 and 0.974 which suggests that national healthcare system productivity efficiency decays by 1.7% for Model I and 2.6% for Model II, respectively. This suggests that the health care system inefficiencies across the ASEAN region have not made life expectancy to improve as much as it should be and curtailed the mortality rate from growing chronic NCDs within a decade. The region is likely to lag behind in achieving SDGs 3 target 4 on reducing by one-third premature mortality from chronic NCDs unless the health care system's technical efficiency is improved across the region. The finding suggests a microlevel study on each country to identify major sources of healthcare system inefficiency in a bid to ameliorate it.