Health  Vol.8 No.10 , July 2016
Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease
Abstract: Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.
Cite this paper: Salihu, A. and Umar, A. (2016) Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease. Health, 8, 971-977. doi: 10.4236/health.2016.810100.

[1]   World Health Organization (2011) Sickle Cell Disease and Other Haemoglobin Disorders, Fact Sheet No 308.

[2]   David, C.R., Thomas, N.W. and Mark, T.G. (2006) Sickle Cell Disease. The Lancet, 376, 2018-2031.

[3]   Weatherall, D.J., Akinyaju, O., Fucheroen, S., Olieveri, N.F. and Musgrove, P. (2010) “Inherited Disorders of Haemoglobin” in Disease Control Priorities in Developing Countries. Oxford University Press, New York.

[4]   Mayer, M.L., Konrad, T.R. and Dvorak, C.C. (2003) Hospital Resources Utilization among Patients with Sickle Cell Disease. Journal of Health Care for the Poor and Underserved, 14, 122-135.

[5]   Blanchet, N.J., Fink, G. and Osei-Akoto, I. (2012) The Effect of Ghana’s National Health Insurance Scheme on Health Care Utilisation. Ghana Medical Journal, 46, 76-84.

[6]   Sanusi, R.A. and Awe, A.T. (2009) An Assessment of Awareness Level of National Health Insurance Scheme among Health Care Consumers in Oyo State, Nigeria. The Social Science, 2, 143-148.

[7]   Sulzbach, S., Garslong, B. and Owusu-Banahene, G. (2005) Evaluating the Effect of National Health Insurance Act in Ghana; Baseline Report. United States Agency for International Development (USAID).

[8]   Luo, X., Liu, G., Frush, K. and Hey, L.A. (2003) Health Insurance Status and Emergency Department Utilization in the United States. Paediatrics, 122, 314-319.

[9]   Center for Disease Control and Prevention (2010) Vital Signs; Health Insurance Coverage and Health Care Utilization, United States—2006-2009: Morbidity & Mortality Weekly Report 1-7.

[10]   Akande, T., Salauddeen, A. and Babatunde, O. (2011) The Effects of National Health Insurance Scheme on Utilization of Health Services at Unilorin Teaching Hospital Staff Clinic, Ilorin Nigeria. Health Science Journal, 5, 98-106.

[11]   Adejoro, L. (2014) NHIS to Achieve 40% Health Coverage. Executive Secretary. Daily Times, 23 January.

[12]   Andersen, R. and Newman, J.P. (1973) Societal and Individual Determinants of Medical Care Utilization in the United States. Milbank Memorial Fund Quarterly Health Society, 51, 95-124.

[13]   Beland, F. (1988) Utilization of Health Services as Events: An Exploratory Study. Health Services Research, 23, 295- 310.

[14]   Speck, S.K., Peyrot, M. and Hsaw, C.W. (2003) Insurance Coverage and Health Care Consumers’ Use of Emergency Departments: Has Managed Care Made a Difference? Journal of Hospital Marketing & Public Relations, 15, 3-18.

[15]   Li-Mei, C., Shi, W.W. and Chung-Yi, L. (2001) The Impact of National Health Insurance on the Utilization of Health Care Services by Pregnant Women: The Case in Taiwan. Maternal and Child Health Journal, 5, 35-42.

[16]   Tanimola, M.A., Salaudeen, A.G., Babatunde, A.O., Durowade, K.A., Agbana, B.E., Olomofe, C.O. and Aibinuomo, A.O. (2012) National Health Insurance Scheme and Its Effect on Staffs Financial Burden in a Nigerian Tertiary Health Facility? International Journal of Asian Social Science, 2, 2175-2185.

[17]   O’Hara, B. and Caswell, K. (2013) Health Status, Health Insurance, and Medical Care Utilization: 2010. Household Economic Studies; Current Population Reports, P70-133RV, 1-16.