STRUCTURAL VIOLENCE AND POLICY OUTCOMES OF ENROLLED JUNIOR OFFICERS IN LAGOS STATE HEALTH INSURANCE SCHEME

Abstract

With the increasing recognition and importance of health for both human welfare and economic progress on a global scale, nations are progressively reinforcing their commitments and dedicating more resources toward initiatives aimed at enhancing healthcare outcomes and societal advancement. However, in Nigeria, significant barriers persist for citizens in accessing quality and affordable healthcare services, despite the presence of the National Health Insurance Scheme. Decentralisation of the scheme's operationalization to the states, aimed at expediting efforts toward universal coverage in healthcare has not effectively countered disparities in healthcare, especially in Lagos State. The operationalisation of the LSHIS seems to reinforce structural violence manifested in escalating out-of-pocket costs, insurance-type discrimination, poor healthcare provision, and favoritism to individuals capable of direct payment. The study thus investigated how structural violence has impacted on the policy outcomes of the LSHIS with an interest in junior officers on grade levels 01-07 in five sampled ministries across Lagos State. To achieve the stated objective, primary data were collected using questionnaire and interviews. Data gathered were analysed using frequency, percentage, and ordinal regression. The study adopted case study research design and employed vulnerability and equity theories as its theoretical framework of analysis. The study's findings indicated that denial of quality healthcare services has negatively impacted the policy outcomes of the scheme, leading to dissatisfaction, self- medication, and increased compensation claims, among other issues. This is due to unavailable resources, significant delays in claims processing by hospitals, and some illnesses not covered by insurance. Furthermore, the study revealed that inequity adversely affects the scheme's policy outcomes, resulting in a lack of trust, accessibility problems, and instances of substandard care. These issues stem from challenges in the reimbursement process, the nature of patients' illnesses, and resource availability. Additionally, the study found that discrimination negatively impacts the scheme's policy outcomes, causing delays in receiving timely care, hesitation in seeking medical attention, and a general sense of reluctance among enrollees. This persistence of discrimination is due to the extensive coverage and higher costs of private insurance compared to state- provided insurance. Finally, the study showed that continuous out-of-pocket payments have led patients to forgo necessary care and not adhere to recommended treatment plans. This is because the current scope of the scheme focuses on common illnesses, and there is a lack of certain medicines in hospital inventories. The study, therefore, recommended expanding the coverage of the health insurance scheme to include a wider range of medical conditions to meet all essential healthcare needs. Also, there should be a feedback mechanism to allow patients to report any bad performance by the healthcare providers. The study concluded that implementing incentive programmes, such as performance- based bonuses and flexible working hours, for healthcare providers within the scheme will enhance quality service delivery, adherence to standards, and patient satisfaction.