Social inclusion in health insurance schemes in Rivers State, Nigeria

BACKGROUND: Social health insurance (SHI) is a key tool for achieving universal healthcare by pooling funds to provide financial protection and cross-subsidisation. Many vulnerable groups remain excluded from health insurance coverage, and implementing strategies to expand coverage among these populations is essential for reducing inequities. This study determined and compared the role of public, private, and community-based health insurance schemes in enhancing social inclusion in health care services in Rivers State. METHODS: A mixed-method study was conducted in Rivers State, gathering data from health insurance enrollees to assess the inclusion of vulnerable individuals within their households in health insurance schemes. The data were analysed using STATA version 14 and NVIVO vs (for quantitative and qualitative data, respectively) with a significance level set at 0.05. RESULTS: The study found that the presence of pregnant women in households is significantly associated with a 21.19% increase in the likelihood of opting for community-based insurance [p = 0.024, CI = 0.0278-0.3960]. In contrast, other sociodemographic factors, including having children that are under-five, adults above 60 years, physically challenged individuals, and visually impaired individuals, did not demonstrate statistically significant effects on insurance selection across public, private, or community schemes. Notably, premium payment consistently emerged as a significant barrier to selecting both public (OR = 0.11, p < 0.001) and community insurance (OR = 0.10, p < 0.001). CONCLUSION: A significant portion of the most vulnerable individuals were excluded from health insurance schemes. Therefore, it is essential for these schemes to implement measures that promote social inclusion for vulnerable populations.