Trends in Health Service Utilization by Insured and Uninsured Patients at a Community-Based Health Insurance Scheme (2011–2023) in a Cottage Hospital in Niger Delta, Nigeria

Background: A community-based health insurance scheme (CBHIS) is a non-profit health insurance program that provides risk pooling to cover the cost of health care services to provide access to basic healthcare needs of the community members. This study examined the trend of utilization of health services by the CBHIS insured and uninsured clients at the Obio Cottage Hospital (OCH), Port Harcourt, Rivers State, Nigeria, between 2011 and 2013. Methods: This was a retrospective cross sectional study design which reviewed health records at the OCH, between 2011 and 2023. The patients were disaggregated as insured or uninsured, outpatients, admissions, antenatal care, deliveries, family planning, and laboratory services. Data were analyzed in an Excel spreadsheet (descriptive statistics) and SPSS version 26 (chi square tests). Results: There was a steady increase in the utilization of the CBHIS for the OPD from 3982 in 2011 to 11642 (292% increase) in 2023. The number of clients who used CBHIS for ANC also increased by 129% (from 2539 in 2011 to 3266 in 2023) There were statistically significant increase in the CBHIS utilization for health services in 2023 compared to 2011; OPD (χ²=0.043, p=0,001), Admission (X2=119.4, p<0.001), Ante-Natal Clinic (ANC), (χ²= <0.014, P=0.001), deliveries (χ²=148.2, p<0.001), laboratory (χ²=330.2, p<0.001) and pharmacy (χ²=0.18, p=0.001) Conclusion: The trend of utilization of health services by the CBHIS insured clients experienced significant increase at the OCH during the study period. This emphasizes the need for CBHIS in developing countries toward the realization of the Universal Health Coverage.