HEALTH INSURANCE COVERAGE AND FINANCIAL PROTECTION AMONG LOW-INCOME HOUSEHOLDS IN NIGERIA: EVIDENCE FROM THE NATIONAL HEALTH INSURANCE AUTHORITY (NHIA)

The health financing system in Nigeria is highly dependent on out-of-pocket (OOP) payments, which exposes households to catastrophic health expenditure (CHE) and impoverishment. Although the National Health Insurance Authority (NHIA) Act 2022 provides for coverage for all Nigerians, insurance penetration is extremely low, especially among low-income earners. This study investigated the relationship between health insurance coverage and financial protection among low-income households in Nigeria, testing whether coverage is negatively associated with OOP expenditure, CHE and delayed or forgone care. A quantitative explanatory design was applied to secondary data from the Nigeria General Household Survey (NGHS) 2023/2024, restricted to households in the lowest two consumption expenditure quintiles. Current enrolment status indicated coverage; OOP expenditure, CHE incidence at the 10% and 40% thresholds, delayed or forgone care, and coping strategies indicated financial protection. Data were analysed using descriptive statistics, chi-square tests, and multivariable logistic regression adjusted for the complex survey design. Only 2.2% of households were insured, and CHE incidence was 45.5% nationally, rising to 52.7% among rural poor households. Among the insured, coverage was associated with a 42% reduction in OOP expenditure during health shocks and significantly lower odds of CHE (AOR = 0.82, p = 0.042), although extremely low coverage limits protection at the population level. Health insurance in Nigeria is not yet providing meaningful financial protection. Expanding subsidised enrolment, improving benefit packages, and tracking financial protection outcomes are needed.