Women's Insurance for State Health - An Impact Evaluation of Health Insurance Provided Under the Basic Health Care Provision Fund in Taraba State, Nigeria
Trial Snapshot
- Phase
- Not Applicable
- Status
- Active, not recruiting
- Sponsor
- Enrollment
- 4,000
- Locations
- 1
- Primary Endpoint
- Respondent has health insurance
Study Overview
Brief Summary
The objective of this study is to examine the impact of a free health insurance offer on healthcare use, spending, self-reported health, and economic participation of women in Taraba state of Nigeria.
Detailed Description
This study aims to evaluate a health-insurance intervention implemented under the World Bank-funded Nigeria for Women Project (NFWP) in Taraba State. Women in Women Affinity Groups (WAGs) received an offer for a free, 12-month policy under the Taraba State Health Insurance Agency's Basic Minimum Package of Health Services (BMPHS), which covers essential primary and secondary care, including consultations, preventive services, maternal and child health, mental health, emergency care, and laboratory services, normally priced at ₦12,000 annually. We are using a randomized controlled trial design in Bali Local Government Area (LGA). Using administrative data on WAG enrollment, we randomly assigned 1,000 WAGs (stratified by ward and mean participant age) to either treatment (n=500) or control (n=500). Within each WAG, four women were randomly selected to enroll in the study, yielding 4,000 participants (2,000 insured; 2,000 controls). The study focuses on outcomes related to healthcare utilization, health status, out-of-pocket expenditures, and women's economic participation. The findings are expected to inform policy on expanding health insurance coverage as a strategy to improve women's health and promote their economic empowerment.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- Single (Outcomes Assessor)
Masking Description
The survey enumerators will not blinded to the treatment status.
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Members of one of 1,000 randomly selected women's groups operating in Bali local government area in Taraba State, Nigeria.
Exclusion Criteria
- •At least 18 years old.
Outcomes
Primary Outcomes
Respondent has health insurance
Time Frame: 6 months, 9 months, 11 months post treatment.
Zero if not no health insurance, 1 if has health insurance.
Has health insurance card
Time Frame: 6 months, 9 months, 11 months post treatment
Zero if respondent has no health insurance card, 1 if they have a health insurance card.
Respondent has successfully used health insurance for consultations, diagnoses, medications, or tests.
Time Frame: 6 months, 9 months, 11 months.
Zero if respondent has not successfully used health insurance for consultations, diagnoses, medications, or tests. 1 if the respondent has successfully used health insurance for consultations, diagnoses, medications, or tests.
Sought treatment for most recent illness
Time Frame: 6 months, 9 months, 11 months.
Zero if respondent did not seek care for most recent illness. 1 if respondent did seek care for most recent illness
Number of health facility visits in last 3 months.
Time Frame: 6 months, 9 months, 11 months.
Reported number of health facility visits outside the home in the last 3 months.
Most recent health facility visit was to a public sector facility
Time Frame: 6 months, 9 months, 11 months.
Zero if last care event was in a private facility, 1 if last care seeking event was in a public facility
Money for health care is a key barrier
Time Frame: 6 months, 9 months, 11 months.
Zero if "getting money needed for advice or treatment" is not listed as a barrier. 1 if "getting money needed for advice or treatment" listed as a barrier.
Most recent birth was in a health facility
Time Frame: 6 months, 9 months, 11 months.
Zero if most recent birth was not in a government or private health facility. 1if most recent birth was in a government or private health facility. Limited to births in last 3 months.
Child has received any vaccinations
Time Frame: 6 months, 9 months, 11 months.
Zero if children aged under 12 months has not received any vaccinations. 1 if child has received at least one vaccination.
Total cost of most recent healthcare
Time Frame: 6 months, 9 months, 11 months.
Total cost of most recent healthcare visit, winsorized at the 1% and 99% levels.
Most recent care episode reflects catastrophic health expenditure
Time Frame: 6 months, 9 months, 11 months.
1 if most recent healthcare visit expenditure represents represents greater than 10% of household consumption
Total indebtedness from healthcare or illness-related expenses
Time Frame: 6 months, 9 months, 11 months.
Total amount of money owed for medical expenses, winsorized at the 1% and 99% levels.
Respondent is depressed
Time Frame: 6 month, 9 month, 11 month.
Score equal to or greater than 10 on Center for Epidemiologic Studies Depression Scale.
Perceived health status
Time Frame: 6 months, 9 months, 11 months.
Response to the following question: Think about your health over the last 3 months, including any long-term illnesses, hospital or clinic visits, or other ailments, how would you rate your health on a scale of 1-10 where 1 is very low health and 10 is very healthy with no ailments?
Number of productive days lost to severe illness in the past 3 months
Time Frame: 6 months, 9 months, 11 months
Reported number of productive days lost to severe illness in the past 3 months
Secondary Outcomes
- Has ever tried to use health insurance(6 months, 9 months, 11 months post treatment)
- Number of antenatal care visits(6 months, 9 months, 11 months.)
- Most recent health facility care event visit was to a secondary/tertiary care facility (hospital)(6 months, 9 months, 11 months.)
- Received lab test as part of antenatal care in most recent pregnancy(6 months, 9 months, 11 months.)
- Child has received OPV(6 months, 9 months, 11 months.)
- Child has received BCG vaccine(6 months, 9 months, 11 months.)
- Child has received measles vaccine(6 months, 9 months, 11 months.)
- Economically active in the last 7 days(6 months, 9 months, 11 months.)
- Hours engaged in economic activities in the last 30 days(6 months, 9 months, 11 months.)
- Total income over past 30 days.(6 months, 9 months, 11 months.)
- Total value of current savings(6 months, 9 months, and 11 months post treatment.)
- Total value of current borrowing(6 months, 9 months, and 11 months post treatment.)
- Household decision making(6 months, 9 months, and 11 months post treatment.)
- Respondent makes decisions about savings(6 months, 9 months, 11 months post treatment.)
- Health insurance knowledge(6 months, 9 months, 11 months.)
- Trust in state government(6 months, 9 months, 11 months post treatment)
- Trust in local government authority(6 months, 9 months, and 11 months post treatment.)