THE IMPACT OF HEALTH CARE INSURANCE PLANS

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CHAPTER ONE
INTRODUCTION  
1.1     Background of the study
Health care insurance plan has been a growing concern to many developing countries in recent times. Given that health insurance is designed to cover formal and informal sectors, rural and urban locations, low and high income earners, it becomes critical as well as a challenge for developing countries as they seek to design, operate and manage effective health insurance system that benefit all citizens. According to Mossialos et al. (2002) there are basically five forms of health financing available to any country. These include taxation; social health insurance; voluntary and private insurance; out-of-pocket or cash-and-carry; and donations. It is said that identifying a sustainable source of financing health care in the world has indeed become a major issue for discussion across the world’s powerful institutions and stakeholders.
The United Nation and other groupings and organs representing the continents of the world are developing strategies for sustainable health care insurance plan. According to the World Health Organization (WHO), supporting adequate, sustainable, equitable and effective health financing to improve health outcomes is one of the most important goals of the World Health Organization. The Executive Board of WHO and the fifty-eight World Health Assembly have discussed and provided strategic directions on sustainable health financing, universal coverage and social health insurance. Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment"
1.2   Statement of the problem
Health care insurance has become a global challenge to all countries and all persons. The ability of national governments to provide funding for health care and to sustain the funding is a huge responsibility, Nigeria is no exception. New and innovative ways are being developed by Governments all over the world to ensure that basic health care is available to all at affordable prices and is equitable. In line of the above, the study was conducted to find out the impact of health care insurance plan in Nigeria.
1.3   Objectives of the study
1. To determine the impact of health care insurance plan have on Nigerians.
2. To identify the relationship between health care and insurance plan.
1.4   Research questions
1. What impact does health care insurance plan have on Nigerians?
2. Is there a relationship between health care and insurance plan?
1.5   Research hypotheses
Ho: There is no significant impact of health care insurance plans in Nigeria.
Hi: There is significant impact of health care insurance plans in Nigeria.
Ho: There is no relationship between health care and insurance plan.
Hi: There is a relationship between health care and insurance plan.
1.6   Significance of the study
Health insurance is a health insurance risk hedged against the probability that if and when someone unexpectedly becomes sick, requires expensive treatments, or is at the mercy of a chronic condition that requires long-term care they will not fall into dire financial straits. It is a benefit provided through a government agency, private business, or non-profit organization. High-quality health care affects health and wellness. A health insurance policy is a contract between an insurance company and a policy holder intended to safeguard against high and unexpected health care costs. Although policy-holders pay a monthly premium, co-payments, co-insurance, and deductibles, it is expected that the total is far less than that required if paid fully out-of-pocket. Coverage from a health insurance policy or a public health program can greatly relieve the financial burden of health care expenses. Those who are uninsured or under insured can experience financial strain and require assistance from alternative funding sources which may not be available at that time. This study will be educative as it will inform people about the enormous benefit of health care insurance plan and it will also be a reference point for researchers.
1.7   Scope of the study
The study focuses on the impact of health care insurance plans in Nigeria using Lagos University Teaching Hospital (LUTH) in Idi-Araba, Surulere Local Government Area of Lagos State, Nigeria as the case study.
1.8   Limitations of the study
This study has some limitations most especially in the area of data collection. Financial constraints as well as time available for the completion of the study are among other factors that would limit the scope of the study.
1.9   Definition of terms
Health Care:  The maintaining and restoration of health by the treatment and prevention of disease especially by trained and licensed professionals (as in medicine, dentistry, clinical psychology, and public health).
Insurance: An arrangement by which a company or the state undertakes to provide a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a specified premium.
Group Health Insurance Plan: An insurance plan that provides healthcare coverage to a select group of people.                      

REFERENCES
 
Atim, C., 1998. Contribution of mutual health organizations to financing, delivery and access to health care: Synthesis of research in nine west and central african countries.
Ekman, B., 2004. Community-based health insurance in low-income countries: A systematic review of the evidence. Health Policy and Planning, 19: 257-271.
Filmer, D., J. Hammer and L. Pritchett, 1997. Health policy in poor countries: Weak links in the chain. Washington, DC: The World Bank.
Forgia, L., G. and C. Griffin, 1993. Health insurance in practice: Fifteen case studies from developing countries. Hoffmeyer, U. and T. McCarthy, 1994. Financing health care. Dordrecht: Kluwer Academic Publishers.
Hsiao, W.C., 1995. Medical savings accounts: Lessons from singapore. Health Affairs, 7(4): 260-266.
Jesse, M. and O. Schaefer, 2000. Health care systems in transition , estonia. Copenhagen. European Observatory on Health Care Systems.

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