Occurrence of Medical Cases and Utilisation among Enrollees of Private Health Insurance Programme in Kaduna, Nigeria

Main Article Content

Oni, Oluwatobi Dapo
Zakari, Mustapha Mohammed
Okemmiri, Innocentia Chidinma


Aims: This study examines the occurrence of various medical cases presented by enrollees that have subscribed to access healthcare from a network of healthcare providers (HCPs) managed by a Health Maintenance Organisation (HMO) under its Private Health Insurance Programme (PHIP).

Study Design:  A descriptive cross-sectional design was employed.

Methodology: Secondary data from collected or submitted medical encounters in form of bills of registered enrollees (principals and their dependants) who have visited and received treatment from their chosen healthcare providers in Kaduna State between the month of January and December 2019 were purposively compiled and analysed. Cases were classified using the National Health Insurance Scheme (NHIS) Operational Guideline. Frequency tables, charts, percentages and Chi-Square analysis were used with the aid of Statistical Package for Social Sciences (SPSS) 22 at P=.05 level of significance.

Results: A total of 11,156 medical cases were recorded after attrition, 9,525 (85.38%) primary cases and 1,632 (14.62%) secondary cases. Malaria (41.23%) and Respiratory Tract Infection (11.98%) led the primary case table while Hypertension (3.83%) Urology related cases (2.49%) and Diabetes (0.79%) were among the leading secondary cases. Female enrollees had slightly more cases and therefore higher tendencies to seek medical treatment than their male counterpart even though there was no significant relation between gender and type of case.

Conclusion: The study concludes that the awareness and utilization of healthcare services are gradually growing among enrollees under the Private Health Insurance Programme (PHIP). In ensuring that there is an improvement in the health sector of Nigeria and achieving universal health coverage, focus should be on the primary healthcare services with high consideration for research, proper data management and periodic sharing of trends, observations and outcome of researches with the growing health community.

Healthcare financing, out-of-pocket, private health insurance, health maintenance organisations, National Health Insurance Scheme, Universal Health Coverage

Article Details

How to Cite
Dapo, O. O., Mohammed, Z. M., & Chidinma, O. I. (2020). Occurrence of Medical Cases and Utilisation among Enrollees of Private Health Insurance Programme in Kaduna, Nigeria. Asian Journal of Medicine and Health, 18(6), 30-37. https://doi.org/10.9734/ajmah/2020/v18i630215
Original Research Article


Preker AS, Zweifel P, Schellekens OP. Global marketplace for private health insurance: strength in numbers; 2010.

(Accessed April 28, 2020)


Uchenna E. Basics of Healthcare Financing in a Developing Economy; 2019.

[ISBN: 078-978-973-241-8]

Agba AM, Ushie EM, Osuchukwu NC. National Health Insurance Scheme (NHIS) and Employees’ Access to Healthcare Service in Cross River State, Nigeria. Global Journal of Human Social Science. 2010;10(7):9-16.

Apeloko DO. Health Insurance Scheme (NHIS) in Nigeria: An empirical survey. International Journal of Politics and Good Governance. 2017:8(8):976–1195.

Onoka CA. The private sector in national health financing systems: The role of health maintenance organisations and private healthcare providers in Nigeria. PhD thesis, London School of Hygiene & Tropical Medicine. 2014.


Ibe O, Honda A, Etiaba E, Ezumah N, Hanson K, Onwujekwe O. Do beneficiaries’ views matter in healthcare purchasing decisions? Experiences from the Nigerian tax funded health system and the formal sector social health insurance program of the National Health Insurance Scheme. International Journal for Equity in Health. 2017;16:216.

Uzochukwu B, Onwujekwu E, Mbachu C, Okeke C, Molyneux S, Gilson L. Accountability mechanisms for implementing a health financing option: the case of the Basic Health Care Provision Fund (BHCPF) in Nigeria. International Journal for Equity in Health. 2018;17(1): 100.

National Health Insurance Scheme (NHIS). Operation guidelines; 2012.

(Accessed February 13, 2020)


Bertakis KD. Gender Differences in the Utilization of Health Care Services. Fam Pract. 2000;49(2):147-152.

Redondo-Sendino A, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health. 2006;6: 155.

DOI: 10.1186/1471-2458-6-155.

Muhammad F, Abdulkareem JH, Chowdhury AA. Major Public Health Problems in Nigeria: A review. South East Asia Journal of Public Health. 2017;7(1):6-11.

Onwujekwe O, Obi F, Ichoku H, Ezumah N, Okeke C, Ezenwaka U. Assessment of a free maternal and child health program and the prospects for program re-activation and scale-up using a new health fund in Nigeria. Niger J Clin Pract. 2019;22:1516-29.

EY’s Health Reimagined Initiative. The future of health insurance; A road map through change; 2015.

(Accessed April 28, 2020)