This study investigated the influence of socio-demographic variables on the demand for health insurance schemes in Yaba, Lagos, Nigeria. The specific objectives include examining the impact of gender, age, education, income, and occupation on health insurance demand. The research design used in this study is a survey research design, and data was collected through self-reported questionnaires administered face-to-face. The study's sample size was limited to residents of Yaba, Lagos, and the data was analyzed using descriptive and inferential statistics (multiple regression analysis). The study's results indicate that age, education, and occupation have significant relationships with health insurance demand, while gender and monthly income do not appear to have a significant impact. It was concluded that socio-demographic variables have statistically significant influence on the demand for health insurance in Nigeria. The study's findings can inform policymakers in their efforts to improve access and uptake of health insurance schemes in Nigeria. The study recommended, among others, that there should be development of targeted education campaigns to increase awareness and understanding of health insurance among the population. This should focus on the benefits, coverage options, and the importance of health insurance in providing financial protection against healthcare expenses.

1. EFFECT OF SOCIO-DEMOGRAPHIC VARIABLES ON THE
DEMAND FOR HEALTH INSURANCE SCHEME IN NIGERIA
BY
ONI, JAMES TEMIDAYO
MATRICULATION NO: 170202025
BEING A RESEARCH PROJECT SUBMITTED TO
DEPARTMENT OF ACTUARIAL SCIENCE AND INSURANCE
FACULTY OF MANAGEMENT SCIENCE
UNIVERSITY OF LAGOS
AKOKA, YABA
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR
THE AWARD OF BACHELOR OF SCIENCE (B.SC) IN
ACTUARIAL SCIENCE
JULY 2023

2. ii
DECLARATION
This is to declare that this research study titled “Effect of Socio-Demographic Variables on
the Demand for Health Insurance Scheme in Nigeria” was carried out by me as a record of
the original work I undertook guided by the supervision of Prof. Dallah, H.
I also declare that all citations and sources of information used have been properly paraphrased
and clearly acknowledged by means of references. Also, I declare that I am fully responsible
for all errors that may be found in this research study.
_____________________________ _____________
ONI, JAMES TEMIDAYO. DATE
170202025

3. iii
CERTIFICATION
This is to certify that this research study titled “Effect of Socio-Demographic Variables on
the Demand for Health Insurance Scheme in Nigeria” was carried out by Oni, James
Temidayo with the matriculation number: 170202025 from the Department of Actuarial
Science and Insurance, Faculty of Management Sciences, University of Lagos, Akoka-Yaba,
Lagos under my supervision.
_________________________ _____________
PROF. DALLAH, H. DATE
Project Supervisor
________________________ _____________
PROF. DALLAH, H. DATE
Head of Department,
Actuarial Science and Insurance
_____________________ _____________
External Examiner Date

4. iv
DEDICATION
This project work is dedicated to Almighty God.

5. v
ACKNOWLEDGEMENTS
First and foremost, I am indebted to Prof. Dallah, H., the Head of the Department of Actuarial
Science and Insurance, for his guidance, support, and supervision throughout this endeavor.
His expertise and invaluable insights have greatly enriched my research. I would also like to
extend my sincere appreciation to the other lecturers at the department, namely Dr. Shogunro,
A.B., Dr. Abiola, B., Dr. Ajijola, L.A., Dr. Obiwuru, T. (Late), Mr. Allwell, N., and Dr. Mesike,
among others. Their teachings, encouragement, and constructive feedback have played a
crucial role in shaping this project.
I am immensely grateful to my parents, Mr. and Mrs. Temidayo, for their unwavering love,
support, and belief in my abilities. Their constant encouragement has been a source of
inspiration throughout my academic journey. I would also like to acknowledge my brother, Oni
Ezekiel Oluwaseyi, as well as my extended family members, for their understanding,
encouragement, and moral support.
To my dear friends, Olalere Lateef, Olotu Tolulope David, Ademola Emmanuel and others, I
express my deepest appreciation. Your companionship, encouragement, and occasional study
sessions have made this journey more enjoyable and memorable.
I am deeply grateful to each and every individual mentioned above for their contributions and
support, without which this project would not have been possible.

6. vi
TABLE OF CONTENTS
DECLARATION......................................................................................................................ii
CERTIFICATION................................................................................................................. iii
DEDICATION.........................................................................................................................iv
ACKNOWLEDGEMENTS ....................................................................................................v
TABLE OF CONTENTS .......................................................................................................vi
ABSTRACT.......................................................................................................................... viii
CHAPTER ONE ......................................................................................................................1
INTRODUCTION....................................................................................................................1
1.1 Background to the Study.............................................................................................1
1.2 Statement of the Problem............................................................................................2
1.3 Aim and Objectives of the Study ................................................................................3
1.4 Research Questions .....................................................................................................4
1.5 Research Hypotheses...................................................................................................4
1.6 Significance of the Study ............................................................................................5
1.7 Scope of the Study.......................................................................................................6
1.8 Limitations of the Study..............................................................................................6
1.9 Definition of Operational Terms.................................................................................7
CHAPTER TWO .....................................................................................................................9
LITERATURE REVIEW .......................................................................................................9
2.1 Introduction.................................................................................................................9
2.2 Conceptual Review .....................................................................................................9
2.2.1 Healthcare Insurance ...............................................................................................9
2.2.2 National Health Insurance Scheme (NHIS) in Nigeria .........................................12
2.2.3 Private-Owned Health Insurance Scheme in Nigeria............................................14
2.2.4 Determinants of Demand for Health Insurance Scheme in Nigeria ......................16
2.2.5 Barriers to Demand for Health Insurance Scheme in Nigeria...............................19
2.3 Theoretical Review ...................................................................................................21
2.3.1 Social Determinants of Health (SDH) Theory ......................................................21
2.3.2 Health-Belief Model (HBM) .................................................................................23
2.3.3 Theory of Planned Behavior (TPB).......................................................................24
2.4 Empirical Review......................................................................................................26
CHAPTER THREE...............................................................................................................34

7. vii
METHODOLOGY ................................................................................................................34
3.1 Introduction...............................................................................................................34
3.2 Research Design........................................................................................................34
3.3 Population of the Study.............................................................................................34
3.4 Sample Size and Sampling Techniques ....................................................................34
3.5 Research Instrument..................................................................................................35
3.6 Validity and Reliability of Research Instrument.......................................................35
3.7 Method of Data Administration ................................................................................35
3.8 Method of Data Analysis...........................................................................................36
CHAPTER FOUR..................................................................................................................37
DATA ANALYSIS AND PRESENTATION OF FINDINGS............................................37
4.1 Introduction...............................................................................................................37
4.2 Distribution of Respondents......................................................................................37
4.3 Analysis of Questionnaire Items ...............................................................................39
4.4 Tests of Hypotheses ..................................................................................................42
4.5 Discussion of Findings..............................................................................................47
CHAPTER FIVE ...................................................................................................................49
SUMMARY, CONCLUSION AND RECOMMENDATIONS .........................................49
5.1 Summary ...................................................................................................................49
5.2 Conclusion.................................................................................................................50
5.3 Recommendations.....................................................................................................50
5.4 Suggestions for Further Studies ................................................................................51
REFERENCES.......................................................................................................................53
APPENDIX.............................................................................................................................60

8. viii
ABSTRACT
This study investigated the influence of socio-demographic variables on the demand for health
insurance schemes in Yaba, Lagos, Nigeria. The specific objectives include examining the
impact of gender, age, education, income, and occupation on health insurance demand. The
research design used in this study is a survey research design, and data was collected through
self-reported questionnaires administered face-to-face. The study's sample size was limited to
residents of Yaba, Lagos, and the data was analyzed using descriptive and inferential statistics
(multiple regression analysis). The study's results indicate that age, education, and occupation
have significant relationships with health insurance demand, while gender and monthly income
do not appear to have a significant impact. It was concluded that socio-demographic variables
have statistically significant influence on the demand for health insurance in Nigeria. The
study's findings can inform policymakers in their efforts to improve access and uptake of health
insurance schemes in Nigeria. The study recommended, among others, that there should be
development of targeted education campaigns to increase awareness and understanding of
health insurance among the population. This should focus on the benefits, coverage options,
and the importance of health insurance in providing financial protection against healthcare
expenses.
Keywords: Age, Health, Insurance, NHIS, Socio-demographic

9. 1
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
At the global level, health insurance schemes have been implemented to ensure that individuals
have access to quality healthcare services. Health is a crucial aspect of human development
and well-being. According to the World Health Organization (WHO), "Health is a state of
complete physical, mental and social well-being and not merely the absence of disease or
infirmity" (WHO, 2021). Access to quality healthcare is a basic human right and is essential
for achieving sustainable development goals (SDGs) set by the United Nations (UN). In Africa,
healthcare systems are faced with a wide range of challenges such as inadequate funding,
inadequate numbers of healthcare providers, and poor infrastructure (Adewole, Reid, Oni &
Adebowale, 2022; Nwankwor, Okoronkwo, Enebeli, Ogbonna, & Iro, 2020). This has resulted
in a high out-of-pocket expenditure on healthcare services and a high rate of financial
catastrophe among households (Adewole, Reid, Oni & Adebowale, 2022). These challenges
are further compounded by the high burden of disease, poverty, and poor access to healthcare
services (Alawode & Adewole, 2021). As a result, healthcare systems in Africa are struggling
to meet the needs of the population.
In Western Africa, Nigeria is one of the countries that is facing significant challenges in its
healthcare system. The Nigerian healthcare system is characterized by inadequate funding,
inadequate numbers of healthcare providers, and poor infrastructure (Adewole, Reid, Oni, &
Adebowale, 2020; Alawode & Adewole, 2021). These challenges have resulted in poor access
to healthcare services, particularly for the poor and vulnerable populations (Ayinde, Ayobami,
Asaolu, Obembe, Babatunde, & Adeoye, 2022). One of the ways in which the Nigerian
government has attempted to address these challenges is through the implementation of the

10. 2
National Health Insurance Scheme (NHIS). The NHIS is a social health insurance program that
aims to provide financial protection to individuals and families against the costs of healthcare
services (Oriolowo, Asarya, & Olarongbe, 2022). The scheme provides coverage for a wide
range of healthcare services, including hospitalization, diagnostic services, and medications
(Akinyemi, Owopetu & Agbejule, 2021).
The scheme is open to all citizens and legal residents of Nigeria, including enrollees. However,
despite its existence, there is limited research on how socio-demographic variables influence
its demand among the Nigerian populace. The Nigerian citizens have several options for
healthcare coverage. These include the NHIS, private health insurance, and out-of-pocket
payments. The NHIS is the most widely used option with a significant proportion of most civil
servants enrolled in the scheme (Akinyemi, Owopetu, & Agbejule, 2021). However, private
health insurance and out-of-pocket payments are also used by a small proportion of civil
servants and the Nigerian population (Gbadamosi & Famutimi, 2017).
Conducting this research at this point in time is necessary because of the ongoing healthcare
crisis in the country. The healthcare system in Nigeria is facing numerous challenges, and it is
essential to understand how socio-demographic variables affect the demand for the health
insurance scheme in order to improve the healthcare system in Nigeria. Furthermore, with the
ongoing COVID-19 pandemic, the importance of access to quality healthcare services has
never been more apparent (Reed, Wolfe, Greenwood & Lignou, 2023). It is therefore
imperative that this research is conducted in order to improve the healthcare system and ensure
that the Nigerian population have access to quality healthcare services.
1.2 Statement of the Problem
The availability and accessibility of healthcare is a global concern that has been the subject of
much research and discussion in recent years. In Africa, the provision of healthcare has been a

11. 3
major challenge, with many countries facing inadequate healthcare infrastructure and a
shortage of qualified healthcare professionals (Adewole, Reid, Oni, & Adebowale, 2022;
Nwankwor et al., 2020). Western Africa, in particular, has been found to have some of the
lowest healthcare expenditure and the highest maternal and infant mortality rates in the world
(Alawode & Adewole, 2021).
In Nigeria, the National Health Insurance Scheme (NHIS) was introduced in 2005 with the aim
of providing universal access to healthcare for all citizens (Alawode & Adewole, 2021).
However, several studies have shown that the implementation of the NHIS has been beset by
a number of challenges, including poor coverage, inadequate funding, lack of transparency,
and poor service delivery (Adewole, Adeniji, Adegbrioye, Dania, & Ilori, 2020; Alawode &
Adewole, 2021; Ayinde et al., 2022). Also, despite the presence of various health insurance
schemes in the country, there still exists a significant portion of the population that lacks
adequate access to health care services. Understanding the factors that influence the demand
for health insurance is crucial in addressing the gap and improving the overall health care
system in Nigeria, hence the justification for this research.
1.3 Aim and Objectives of the Study
The study aims to provide insights into the key socio-demographic variables that influence the
demand for health insurance and provide recommendations for policy makers to improve
access and uptake of health insurance schemes in Nigeria. The study has the following specific
objectives:
i. To determine the extent to which gender distribution impact the demand for health
insurance schemes in Nigeria
ii. To ascertain the extent to which age distribution affect the demand for health insurance
schemes in Nigeria

12. 4
iii. To evaluate the extent to which educational distribution influence the demand for health
insurance schemes in Nigeria
iv. To investigate the extent to which income distribution impact the demand for health
insurance schemes in Nigeria
v. To examine the extent to which occupational distribution affect the demand for health
insurance schemes in Nigeria
vi. To assess the extents to which socio-demographic variables affect the demand for
health insurance schemes in Nigeria
1.4 Research Questions
The following research questions were answered in the study:
i. What is the relationship between gender and demand for health insurance schemes in
Nigeria?
ii. How does age distribution impact the demand for health insurance schemes in Nigeria?
iii. What is the influence of educational distribution on the demand for health insurance
schemes in Nigeria?
iv. What is the impact of income distribution on the demand for health insurance schemes
in Nigeria?
v. How does occupational distribution affect the demand for health insurance schemes in
Nigeria?
vi. In what way does socio-demographic variables affect the demand for health insurance
schemes in Nigeria?
1.5 Research Hypotheses
The study evaluated the following null hypotheses

13. 5
i. There is no significant difference in the demand for health insurance schemes in Nigeria
between males and females.
ii. There is no significant relationship between age distribution and the demand for health
insurance schemes in Nigeria.
iii. There is no significant relationship between educational distribution and the demand
for health insurance schemes in Nigeria.
iv. There is no significant relationship between income distribution and the demand for
health insurance schemes in Nigeria.
v. There is no significant relationship between occupational distribution and the demand
for health insurance schemes in Nigeria.
vi. There is no significant relationship between socio-demographic variables and the
demand for health insurance schemes in Nigeria.
1.6 Significance of the Study
The significance of this study lies in its contribution to the understanding of the socio-
demographic variables that influence the demand for health insurance schemes in Nigeria. The
findings of this study have the potential to inform policy decisions aimed at improving access
and uptake of health insurance in the country. Moreover, the study can also serve as a reference
for other countries facing similar challenges in promoting health insurance schemes and
addressing gaps in health care access. The results can be used by insurance companies, health
care providers, and government agencies to design and implement more effective health
insurance programs that cater to the needs of different segments of the population.
Additionally, the study can contribute to the academic literature on health insurance demand,
providing further insights into the complex interplay of socio-demographic variables and health
insurance uptake. Overall, this study has the potential to make a meaningful impact on the
health care system in Nigeria and provide valuable information for future research in the area.

14. 6
1.7 Scope of the Study
The scope of this study is limited to understanding the influence of socio-demographic
variables on the demand for health insurance schemes in Yaba, Lagos residents. The study was
based on a survey research design using self-reported data collected through a questionnaire.
The data was collected through face-to-face administration of the questionnaire to ensure
accuracy. The sample size of the study was limited to residents of Yaba, Lagos. The data
collected was analyzed using both descriptive and inferential statistics. The normality and
reliability of the data were tested to ensure validity of the results. The research hypotheses were
tested at 5% level of significance to provide answers to the research questions and determine
the extent to which socio-demographic variables impact the demand for health insurance
schemes in Nigeria. The scope of this study does not extend to a comprehensive analysis of the
Nigerian health insurance sector or a detailed examination of the different health insurance
schemes available in the country. The study only focused on understanding the influence of
socio-demographic variables on the demand for health insurance in Yaba, Lagos residents.
1.8 Limitations of the Study
The findings of the study are specific to Yaba, Lagos residents and are not representative of
the broader population in Nigeria or other geographical locations. This restrict the
generalizability of the results. The data collected for the study is also based on self-reported
data collected through the questionnaire. This method is subject to biases such as social
desirability bias and recall bias, which affects the accuracy and reliability of the responses.
Face-to-face administration of the questionnaire may have also introduced response bias, as
participants might modify their answers or feel pressured to respond in a certain way due to the
presence of an interviewer.

15. 7
The study focuses solely on the influence of socio-demographic variables on the demand for
health insurance schemes. It does not provide a comprehensive analysis of other potential
factors that could affect health insurance demand, such as healthcare needs, affordability, or
awareness. The study also does not compare different health insurance schemes available in
Nigeria or consider the impact of specific policy interventions or changes in the healthcare
system that can influence health insurance demand. While descriptive and inferential statistics
were used to analyze the data, relying solely on statistical analysis alone does not capture the
complexity and nuances of individuals' decision-making processes when it comes to health
insurance.
1.9 Definition of Operational Terms
i. Burden of disease: The impact of diseases and health conditions on individuals,
communities, or populations in terms of morbidity, mortality, or disability.
ii. Demand for health insurance: The willingness and ability of individuals or
populations to enroll in and utilize health insurance schemes to access healthcare
services.
iii. Financial catastrophe: A situation where healthcare expenses exceed a household's
ability to pay, leading to severe financial hardship.
iv. Global level: Referring to the international or worldwide perspective or context.
v. Health insurance schemes: Organized systems that provide financial protection and
access to healthcare services for individuals or populations.
vi. Healthcare systems: Organized networks of institutions, resources, and individuals
involved in providing healthcare services.
vii. Human development: The process of enlarging people's capabilities and freedoms to
lead long, healthy, and fulfilling lives.

16. 8
viii. Infrastructure: The physical and organizational structures and facilities needed for the
operation of healthcare systems, such as hospitals, clinics, and medical equipment.
ix. National Health Insurance Scheme (NHIS): A social health insurance program in
Nigeria aimed at providing financial protection for healthcare services to individuals
and families.
x. Nigerian healthcare system: The structure, organization, and delivery of healthcare
services in Nigeria.
xi. Out-of-pocket expenditure: Direct payments made by individuals for healthcare
services not covered by insurance or other third-party payers.
xii. Quality healthcare services: Healthcare services that meet recognized standards of
safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
xiii. Socio-demographic variables: Characteristics of individuals or populations related to
social factors (e.g., gender, age, education, income, occupation).
xiv. Sustainable development goals (SDGs): A set of 17 goals adopted by the United
Nations to address global challenges and promote sustainable development by 2030.
xv. Well-being: The state of being happy, healthy, and prosperous.

17. 9
CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter comprises the review of related literature on determinants of demand for health
insurance schemes in Nigeria. The chapter is specifically categorized into conceptual review,
theoretical review and empirical review.
2.2 Conceptual Review
This section of the chapter comprises the critical review of important concepts in this study. It
comprises of the review of the concepts of health, healthcare insurance, types of healthcare
insurance, National Health Insurance Scheme (NHIS) in Nigeria, private-owned health
insurance scheme in Nigeria, determinants of demands for healthcare insurance scheme in
Nigeria and barriers to the demands for healthcare insurance scheme in Nigeria.
2.2.1 Healthcare Insurance
Scholars and organizations, such as the World Health Organization (WHO), have provided
several definitions of healthcare. In the 5th century BC, Pindar defined health as the
"harmonious functioning of the organs," emphasizing the physical dimension of health and
overall functionality without discomfort or pain (Altan, Ekiyor & Unalan, 2021). Modern
concepts of health recognize it as more than the absence of disease, highlighting an individual's
capacity for self-realization and fulfillment (López-Otín & Kroemer, 2021). According to the
WHO constitution of 1948, health is defined as the state of complete physical, mental, and
social well-being, rather than just the absence of disease or infirmity.
Engel (1960 cited in Bashmi et al., 2023) developed the biopsychosocial model, which
examines and treats the health of mentally ill patients. This model aligns with the WHO's

18. 10
perspective on health and serves as a conceptual framework for healthcare. However, some
scholars find both the WHO and Engel's definitions too broad and challenging to measure.
Ewurum, Mgbemna, Nwogwugwu and Kalu (2015 cited in Lucky and Ezeabasili, 2020) assert
that health drives economic growth and development. This assertion is supported by the fact
that healthy nations produce more outputs than unhealthy nations. Similarly, Grossman (1972
cited in Schneider-Kamp, 2021) defines health as a durable stock that produces healthy time,
which serves as an output for both market and non-market activities, contributing to utility and
income.
The fundamental premise of healthcare is that all people around the world deserve the right
care in their country. It addresses the majority of a person's health needs throughout their
lifetime, focusing on physical, mental, and social well-being. Healthcare should be people-
centered rather than disease-centered. According to Prade, Rousseau, Saint-Lary, Baumann,
Devillers, Courtin and Gautier (2023), the concept of healthcare has been reinterpreted and
redefined over the years thereby leading to confusion. To facilitate coordination and guide
implementation, a clear and simple definition has been developed to ensure the highest possible
level of health and well-being by addressing people's needs from an early stage.
Usak, Kubiatko, Shabbir, Viktorovna, Jermsittiparsert and Rajabion (2020) posited that health
insurance plays a critical role in delivering and accessing healthcare. Healthcare insurance
providers and individuals enter into agreements known as healthcare insurance plans, in which
individuals pay regular premiums to receive healthcare coverage. These plans guarantee
policyholders access to necessary healthcare services without requiring them to pay out-of-
pocket expenses. Providing health insurance plans to enrollees in Nigeria is crucial for ensuring
their welfare and promoting a healthy workforce. Healthcare insurance plans cater to the
diverse healthcare needs of individuals and come with varying coverage, premiums, and
benefits (Mbau, Kabia, Honda, Hanson & Barasa, 2020). Therefore, individuals must choose

19. 11
plans that meet their specific requirements. In Nigeria, there are different types of healthcare
insurance plans available, and these are briefly discussed below:
The National Health Insurance Scheme (NHIS): Established in 1999, the NHIS provides
universal healthcare coverage for Nigerians. It is mandatory for federal government employees
and optional for individuals in the private sector (Alawode & Adewole, 2021). Health
Maintenance Organizations (HMOs) operate under the NHIS to provide healthcare services to
enrollees. According to Ogundeji et al. (2023), the scheme offers various packages such as the
formal sector package, Tertiary Institution Social Health Insurance Programme (TISHIP), and
voluntary contributors social health insurance programme (VCSHIP). These packages have
different premiums, coverage, and benefits, requiring individuals to choose the ones that align
with their needs.
Private Health Insurance: Shobiye, Dada, Ndili, Zamba, Feeley and de Wit (2021)
maintained that private insurance companies in Nigeria offer private health insurance plans.
These plans provide individuals with access to private healthcare services and are designed to
meet diverse healthcare needs. As the coverage, premiums, and benefits of private health
insurance plans vary, individuals must select plans that suit their requirements.
Community-Based Health Insurance Scheme (CBHIS): The CBHIS is a healthcare
financing model aimed at low-income earners and individuals in rural areas. This community-
driven model involves pooling resources to provide healthcare coverage for members, ensuring
affordable healthcare for those unable to afford private health insurance plans (Hsiao & Yip,
2023).
Employer-Provided Health Insurance: Under this healthcare financing model, employers
offer healthcare coverage for their employees. The coverage, premiums, and benefits of these
plans vary based on the employer's policy (Dartanto et al., 2020).

20. 12
Healthcare insurance plans offer numerous benefits to Nigerian citizens. They provide access
to affordable healthcare services, ensuring beneficiaries can receive necessary care without
significant out-of-pocket expenses (Alawode & Adewole, 2021). The comprehensive coverage
includes inpatient and outpatient care, maternity care, and dental care, addressing various
health needs. Healthcare insurance plans promote improved health outcomes among enrollees
by facilitating timely access to healthcare services, leading to early detection and treatment of
health conditions. They also alleviate the financial burden on enrollees, as they do not have to
pay out-of-pocket expenses when seeking healthcare services. Also, these plans contribute to
improved employee retention (Shobiye et al., 2021; Dartanto et al., 2020). By providing
healthcare insurance coverage as part of employment benefits, staff welfare, job satisfaction,
and retention are promoted.
Despite the benefits, healthcare insurance plans face several challenges. Firstly, Malik-Soni et
al. (2022) argued that the coverage offered is often limited, making it difficult for enrollees to
access specialized healthcare services. Secondly, high premiums pose affordability challenges
for enrollees (Bustamante, Chen, Félix & Ortega, 2021). Furthermore, provider networks for
healthcare insurance plans are often inadequate, hindering enrollees’ access to healthcare
services (Agyemang-Duah, Peprah & Peprah, 2019). Lastly, the claims processes for healthcare
insurance plans are frequently inefficient, resulting in delays in accessing healthcare services
and receiving reimbursement for incurred expenses (Malik-Soni et al., 2022).
2.2.2 National Health Insurance Scheme (NHIS) in Nigeria
The National Health Insurance Scheme (NHIS) is a government agency in Nigeria that was
established in 2005 with the aim of providing accessible and affordable healthcare to all
residents of the country (Alawode & Adewole, 2021). The NHIS operates as a social health
insurance program, pooling funds from various sources to ensure that individuals have access

21. 13
to healthcare services without facing financial hardship. The NHIS is governed by the National
Health Insurance Scheme Act of 1999 and is regulated by the National Health Insurance
Scheme Council. Its primary objectives include providing financial risk protection, improving
access to quality healthcare services, and reducing out-of-pocket expenses for healthcare in
Nigeria (Adebisi, Umah, Olaoye, Alaran, Sina-Odunsi & Lucero-Prisno, 2020).
One of the key features of the NHIS is its focus on enrollment in health insurance plans. The
scheme operates on a contributory basis, where individuals and employers are required to make
regular payments to the NHIS in exchange for healthcare coverage (Michael, 2021). According
to Alawode and Adewole (2021), the scheme offers various programs and plans that cater to
different categories of individuals, including the formal sector (employees of government
agencies, private organizations, and their dependents), the informal sector (self-employed
individuals, artisans, traders, and their dependents), and vulnerable populations (such as the
elderly, children, pregnant women, and those living in poverty).
The NHIS works in collaboration with accredited healthcare providers, including public and
private hospitals, clinics, and healthcare facilities, to ensure that beneficiaries have access to
quality healthcare services (Shobiye et al., 2021). These healthcare providers must meet certain
standards and undergo a certification process to be eligible to provide services under the NHIS.
It also operates through the implementation of various programs and initiatives (Adewole,
Reid, Oni & Adebowale, 2022). Some of these programs include the Formal Sector Social
Health Insurance Program, the Informal Sector Social Health Insurance Program, the Maternal
and Child Health Program, and the Vulnerable Group Program. These programs aim to target
specific segments of the population and provide them with comprehensive healthcare coverage.
Despite its establishment and efforts to improve healthcare access, the NHIS faces several
challenges. One of the main challenges is low enrollment rates, particularly among the informal

22. 14
sector and vulnerable populations (Shobiye et al., 2021; Alawode & Adewole, 2021; Kipo-
Sunyehzi, Ayanore, Dzidzonu & AyalsumaYakubu, 2019). Many individuals are still unaware
of the benefits of health insurance or face affordability issues, leading to a significant
proportion of the population being uninsured. Also, the quality of healthcare services provided
under the NHIS is variable, with some beneficiaries reporting difficulties in accessing timely
and appropriate care (Alqutub, 2022). However, in recent years, there have been ongoing
efforts to reform and strengthen the NHIS. These include initiatives to increase public
awareness about health insurance, expand coverage to underserved areas, improve the quality
of healthcare services, and enhance accountability and transparency within the scheme
(Nwankwor et al., 2020).
2.2.3 Private-Owned Health Insurance Scheme in Nigeria
Private-owned health insurance schemes in Nigeria play a significant role in the country's
healthcare system. According to Glied, Collins and Lin (2020), these schemes are offered by
various insurance companies and are designed to provide individuals and families with
financial coverage for medical expenses. This type of health insurance schemes typically offer
coverage for a wide range of medical services. These include hospitalization, surgical
procedures, consultations with specialists, diagnostic tests, prescription medications, and
sometimes even preventive care services (Askin & Moore, 2022). The coverage and benefits
can vary depending on the specific plan and the insurance provider.
According to Oni, Zakari and Okemmiri (2020), insurance companies offering private health
insurance schemes in Nigeria usually have a network of healthcare providers, including
hospitals, clinics, and doctors, with which they have agreements. These agreements allow
policyholders to receive medical services from the network providers at a reduced cost or with
direct billing arrangements. However, the choice of healthcare providers are limited to those

23. 15
within the insurer's network, which can sometimes be a drawback for individuals seeking care
from specific providers or institutions.
To obtain coverage under private health insurance schemes, individuals and families are
required to pay premiums. The amount of the premium is determined based on various factors,
including the coverage provided, the age of the insured, and any pre-existing medical
conditions (White & Whaley, 2019). Also, policyholders also have to share the cost of
healthcare services through deductibles, co-payments, or co-insurance, depending on the terms
of their insurance policy (Lu, Gan & Chen, 2023). Private health insurance schemes in Nigeria
often have provisions related to pre-existing medical conditions. Policyholders are subjected
to waiting periods before coverage for pre-existing conditions kicks in. During this waiting
period, any medical expenses related to these conditions are not usually covered (Ojifinni &
Ibisomi, 2022). It is essential for individuals to thoroughly review the policy terms and
conditions to understand the coverage limitations and waiting periods, particularly if they have
pre-existing conditions.
When policyholders receive medical services covered by their insurance schemes, they must
file claims with the insurance company to seek reimbursement or direct payment to the
healthcare provider (Shobiye et al., 2021). The claims process typically involves submitting
relevant documentation, such as medical bills, receipts, and diagnostic reports, to the insurance
company for review and processing. The efficiency and transparency of the claims process can
vary among insurance providers, and delays or disputes can sometimes occur. Private-owned
health insurance schemes in Nigeria have certain limitations and exclusions. These include
specific medical treatments or procedures that are not covered, such as cosmetic surgery or
experimental therapies (Ojifinni & Ibisomi, 2022). In addition, there are limitations on the
number of hospital days covered, caps on specific benefits, or exclusions related to certain

24. 16
conditions or age groups (Alawode & Adewole, 2021). It is crucial for individuals to carefully
review the policy terms and conditions to understand these limitations and exclusions.
According to James and Isah (2021), private health insurance schemes in Nigeria are regulated
by the National Health Insurance Scheme (NHIS) and the National Insurance Commission
(NAICOM). These regulatory bodies oversee the activities of insurance companies, ensuring
compliance with guidelines, licensing requirements, and consumer protection measures.
However, it is important to note that the regulatory landscape and enforcement vary, and
consumers need to choose insurance providers that are reputable and comply with regulatory
standards.
2.2.4 Determinants of Demand for Health Insurance Scheme in Nigeria
Health insurance plays a crucial role in ensuring access to quality healthcare services and
protecting individuals from the financial burden of medical expenses (Alawode & Adewole,
2021). In Nigeria, where healthcare delivery faces numerous challenges, the demand for health
insurance schemes is influenced by various determinants as follows:
Income Level: According to Akintunde, Oladipo and Oyaromade (2019), income level is a
fundamental determinant of health insurance demand. In Nigeria, where a significant
proportion of the population lives below the poverty line, affordability remains a major
obstacle. Low-income individuals often find it challenging to allocate resources for health
insurance premiums, even when they recognize its importance. The affordability of health
insurance schemes is further exacerbated by the high cost of healthcare services, limited
coverage options, and inadequate financial protection (Adebisi, et al. 2020).
Educational attainment and awareness: These play a pivotal role in shaping the demand for
health insurance. Individuals with higher levels of education tend to be more aware of the
benefits and importance of health insurance, leading to increased demand (Reiners, Sturm,

25. 17
Bouw & Wouters, 2019). However, in Nigeria, a significant portion of the population has
limited access to quality education, resulting in low levels of health insurance literacy
(Alawode & Adewole, 2021). Lack of awareness about the existence, benefits, and functioning
of health insurance schemes creates a barrier to demand.
Trusts in the Scheme: The perceived quality and trustworthiness of health insurance schemes
significantly influence demand (Chan et al., 2020). Nigerians often perceive the quality of
healthcare services offered through health insurance schemes as subpar compared to out-of-
pocket payment options. This perception can stem from previous experiences, lack of
information, or the overall state of the healthcare system. Building trust in health insurance
schemes requires efforts to improve service quality, enhance transparency, and effectively
communicate the advantages and coverage options to potential beneficiaries (Li et al., 2020).
Cultural and social factors: This also influence the demand for health insurance schemes in
Nigeria. According to Cogbum (2019), traditional beliefs and practices related to health,
coupled with societal norms, can shape individuals' perception of insurance and their
willingness to participate. Also, extended family systems and community support mechanisms
play a significant role in managing healthcare expenses, reducing the perceived need for health
insurance among certain segments of the population (Li et al., 2020).
Government Policies and Regulations: Government policies and regulations have a profound
impact on the demand for health insurance schemes. The Nigerian government has taken steps
to promote health insurance coverage, such as the enactment of the National Health Insurance
Scheme (NHIS) Act (Alawode & Adewole, 2021). However, the implementation of these
policies has faced challenges, including limited coverage, inadequate enforcement, and
inefficient administration (Shobiye et al., 2021). Inconsistencies in policy implementation can

26. 18
hinder the demand for health insurance schemes, as potential beneficiaries may question the
reliability and effectiveness of such programs (Nwankwor et al., 2020).
Quality and accessibility of healthcare services: These directly influence the demand for
health insurance schemes. In Nigeria, where healthcare infrastructure and service delivery are
often suboptimal, individuals may question the value of health insurance. Limited access to
healthcare facilities, long waiting times, and inadequate medical supplies contribute to the
skepticism surrounding health insurance schemes (Ouma, Masai & Nyadera, 2020). Improving
the overall healthcare system and ensuring the availability of quality services can enhance the
demand for health insurance by instilling confidence in potential beneficiaries.
Gender distribution: This is another significant determinant of the demand for health
insurance in Nigeria. Historically, women in Nigeria have faced numerous social and economic
challenges, including limited access to education, employment opportunities, and decision-
making power (Ali & Salisu, 2019). These factors contribute to their vulnerability and
influence their demand for health insurance. Women often bear the responsibility of healthcare
decisions for themselves and their families, which increases their need for comprehensive
health coverage (Stokes & Patterson, 2020). In addition, women's healthcare needs differ from
those of men due to reproductive health issues and maternity care. Health insurance schemes
that cater specifically to women's needs, such as coverage for prenatal care and childbirth, can
significantly influence their demand for insurance (Kofinti, Asmah & Ameyaw, 2022).
Ensuring gender equity in health insurance provision, addressing gender-based discrimination,
and promoting financial inclusivity are crucial steps toward increasing the demand for health
insurance among women in Nigeria.
Age Distribution: According to Dankwah, Zeng, Feng, Kirychuk and Farag (2019), the age
distribution of the population is another crucial determinant of health insurance demand.

27. 19
Nigeria has a youthful population, with a large proportion of individuals under the age of 30.
Younger individuals generally have lower healthcare utilization rates and perceive themselves
to be healthier, resulting in lower demand for health insurance. Moreover, the youth often
prioritize other financial commitments, such as education and housing, over health insurance
coverage. However, as individuals age, the likelihood of experiencing health issues and the
need for healthcare services increases (Islam, 2019). Thus, there is a need for policies that
encourage early enrollment in health insurance schemes to secure affordable premiums and
comprehensive coverage. Educating young Nigerians about the benefits of health insurance,
promoting preventive care, and emphasizing the potential financial risks associated with
unforeseen medical expenses can help stimulate demand among the younger population.
Occupational Distribution: These plays a critical role in determining the demand for health
insurance in Nigeria. The country has a significant informal sector, comprising self-employed
individuals, street vendors, and small business owners. Many of these individuals lack access
to employer-sponsored health insurance, making them reliant on public health facilities or out-
of-pocket payments. Occupational groups with higher incomes and formal employment often
have better access to health insurance through employer-provided schemes (Chatterjee, Nayak
& Mahakud, 2023). This disparity in coverage creates an imbalance in the demand for health
insurance across different occupational groups. It is essential to develop policies that extend
health insurance coverage to the informal sector, including targeted programs, subsidies, and
incentives for voluntary enrollment.
2.2.5 Barriers to Demand for Health Insurance Scheme in Nigeria
The demand for health insurance in Nigeria faces several barriers that need to be addressed for
the effective implementation of comprehensive health coverage. These barriers are as follows:

28. 20
Lack of Awareness and Information: One of the primary barriers to the demand for health
insurance in Nigeria is the lack of awareness and information about the benefits and functioning
of insurance schemes (Shobiye et al., 2021; Adegboyega, Nkwonta & Edward, 2020). Many
Nigerians are unaware of the existence and importance of health insurance, leading to a limited
demand. The absence of comprehensive public campaigns and educational programs prevents
potential beneficiaries from understanding the advantages of health insurance, thus hindering
demand.
Low Perceived Value: A significant obstacle to health insurance demand in Nigeria is the low
perceived value among potential beneficiaries (Akokuwebe & Idemudia, 2022). Due to the
inefficiencies and challenges within the healthcare system, individuals doubt the effectiveness
and quality of healthcare services covered by insurance schemes. A lack of trust in the
healthcare system can discourage people from seeking health insurance, resulting in low
demand.
Affordability and Financial Constraints: Alawode and Adewole (2021) also posited that
affordability is a critical barrier to health insurance demand in Nigeria. Many Nigerians
struggle with financial constraints, and the cost of health insurance premiums are unaffordable
for a significant portion of the population. Also, the lack of income stability and irregular cash
flows make it challenging for individuals to commit to regular premium payments, further
reducing the demand for health insurance (Nwankwor et al., 2020)
Limited Coverage and Benefit Packages: The limited coverage and benefit packages offered
by health insurance schemes in Nigeria present another barrier to demand (Uzochukwu, Okeke,
O’Brien, Ruiz, Sombie & Hollingworth, 2020). Some insurance plans do not adequately cover
essential healthcare services, including preventive care and chronic disease management. The

29. 21
lack of comprehensive coverage options reduces the attractiveness of health insurance and
discourages potential beneficiaries from seeking enrollment.
Inadequate Healthcare Infrastructure: Nigeria's healthcare infrastructure is insufficient,
particularly in rural areas. Limited access to healthcare facilities, shortage of healthcare
professionals, and inadequate medical equipment pose significant barriers to health insurance
demand (Shobiye et al., 2021). When potential beneficiaries perceive a lack of healthcare
infrastructure, they are less inclined to seek health insurance as they may believe that even if
they are insured, they will not be able to access the necessary healthcare services.
Trust and Perception of Insurance Providers: The lack of trust in insurance providers is
another key barrier to health insurance demand. Nigerians are usually skeptical about insurance
companies due to a perceived lack of transparency, delayed claim payments, and ambiguous
policy terms and conditions (Alawode & Adewole, 2021). The mistrust in insurance providers
negatively impacts the demand for health insurance, as individuals opt for informal healthcare
financing mechanisms rather than relying on insurance.
2.3 Theoretical Review
This section comprises the review of relevant theories which can be used to explain the socio-
demographic variables that determines the demand for health insurance in Nigeria. The theories
reviewed include the Social Determinants of Health (SDH) theory, the Health-Belief Model
(HBM) and the Theory of Planned Behavior (TPB).
2.3.1 Social Determinants of Health (SDH) Theory
One theory that can be used to explain the key socio-demographic variables influencing the
demand for health insurance in Nigeria is the Social Determinants of Health (SDH) theory. The
SDH theory posits that the social and economic conditions in which individuals are born, live,
work, and age have a significant impact on their health outcomes (Fisher, 2019). In the context

30. 22
of health insurance demand, the theory suggests that socio-demographic factors such as gender,
age, education, income, and occupation play a crucial role.
The concept of social determinants of health originated in the field of public health and gained
prominence through the World Health Organization's Commission on Social Determinants of
Health in 2005. It emerged as a response to the recognition that health outcomes are not solely
determined by individual behavior or access to healthcare but are heavily influenced by social
and economic factors. The SDH theory assumes that individuals' health outcomes are shaped
by factors beyond their control, such as social class, income, education, occupation, and gender.
It argues that these factors create unequal opportunities and resources that ultimately influence
health and health-seeking behaviors, including the demand for health insurance (Tsakos, Watt
& Guarnizo- Herreño, 2023).
The theory has garnered support from various researchers, policymakers, and organizations
globally. Its advocates argue that addressing social determinants of health can lead to more
equitable health outcomes and reduce health disparities (Baum, Delany-Crowe, MacDougall,
Van Eyk, Lawless, Williams & Marmot, 2019). In the context of health insurance demand in
Nigeria, supporters of the theory emphasize the need to consider socio-demographic variables
to design effective health insurance policies and programs. While the theory has gained
considerable recognition, it also faces some criticism. Critics argue that it oversimplify
complex health issues by focusing predominantly on social factors. They suggest that
individual behaviors and choices should not be disregarded in understanding health insurance
demand. Also, critics question the extent to which social determinants can be modified through
policy interventions, highlighting the complex nature of the relationship between social factors
and health outcomes (Carroll et al., 2022).

31. 23
The SDH theory has been applied in various ways to inform health policy and practice. In the
context of health insurance in Nigeria, the theory can guide policymakers in identifying target
populations and tailoring health insurance programs to meet their specific needs. For example,
recognizing that education is a key determinant, policies could focus on improving health
insurance literacy and awareness among different educational groups. Similarly, income and
occupation can be considered when designing subsidy programs or determining premium
levels to ensure affordability and accessibility for different socio-economic groups.
2.3.2 Health-Belief Model (HBM)
The Health-Belief Model (HBM) is a psychological model that suggests that an individual's
decision to engage in health-related behaviors, including the purchase of health insurance, is
influenced by their perceptions and beliefs about health risks and benefits, as well as other
individual-level factors. The model was developed in the 1950s by social psychologists
Hochbaum, Rosenstock, and others. It was initially designed to explain and predict individuals'
engagement in preventive health behaviors such as vaccination, but it has since been applied
to various health-related behaviors, including health insurance uptake (Ataei, Gholamrezai,
Movahedi & Aliabadi, 2021).
According to Anuar, Shah, Gafor, Mahmood and Ghazi (2020), HBM is based on several key
assumptions. Firstly, it assumes that individuals weigh the perceived benefits and barriers of a
health-related action, such as purchasing health insurance, before deciding to engage in that
behavior. Secondly, it assumes that an individual's decision-making process is influenced by
their perception of the severity and susceptibility to a particular health condition, as well as
their perception of the efficacy and costs of the recommended behavior. Lastly, the model
assumes that individuals are motivated by cues to action, such as personal experiences, advice
from healthcare providers, or information campaigns.

32. 24
The model has found support among researchers and practitioners in the field of public health.
Its emphasis on individuals' perceptions, beliefs, and motivation has been useful in
understanding and promoting health-related behaviors (Sarwar, Panatik & Jameel, 2020;
Huang, Dai & Xu, 2020; Wang, Wen, Zhu, Xiong & Liu, 2022). In the context of health
insurance demand in Nigeria, supporters of the model argue that understanding individuals'
perceptions of the risks and benefits of health insurance can help design interventions to
increase uptake. HBM has also faced criticism over the years. Critics argue that the model
oversimplifies decision-making processes by focusing primarily on cognitive factors and
disregarding social and structural determinants of behavior. They suggest that factors such as
social norms, peer influence, and access to healthcare services may have a more significant
impact on health insurance demand than individual beliefs alone (Huang, Dai & Xu, 2020).
The model has been widely applied in health promotion and behavior change interventions. In
the context of health insurance demand in Nigeria, the model can be used to identify potential
barriers and facilitators to purchasing health insurance among different socio-demographic
groups. For example, it can help identify specific beliefs or misconceptions about health
insurance that may deter certain individuals from enrolling. This information can be used to
design targeted educational campaigns or address affordability concerns to increase demand.
2.3.3 Theory of Planned Behavior (TPB)
Theory of Planned Behaviour (TPB) is a social psychological theory that suggests that people's
behavioral intentions are influenced by their attitudes, subjective norms, and perceived
behavioral control. The theory was developed by Icek Ajzen in the late 1980s as an extension
of the earlier Theory of Reasoned Action (TRA). It was designed to explain and predict various
behaviors, including health-related behaviors (Huang, Dai & Xu, 2020). TPB is based on
several key assumptions. Firstly, it assumes that individuals have the intention to engage in a

33. 25
specific behavior, such as purchasing health insurance, before actually doing so. Secondly, it
assumes that behavioral intentions are influenced by three factors: attitudes towards the
behavior, subjective norms (perceived social pressure to perform the behavior), and perceived
behavioral control (perceived ease or difficulty of performing the behavior). These factors, in
turn, are influenced by socio-demographic variables and other individual-level characteristics
(Bosnjak, Ajzen & Schmidt, 2020).
TPB has received support from researchers and practitioners in various fields, including health
promotion and behavioral sciences. Its emphasis on attitudes, subjective norms, and perceived
behavioral control provides a framework for understanding and predicting behavior, including
health insurance demand. Supporters of the theory argue that by addressing the factors that
influence behavioral intentions, interventions can be designed to increase health insurance
uptake (Wei, Xu, Yang, Gao, Kuang & Zhou, 2023). The TPB, like any theory, has faced
criticism. Critics argue that the theory does not fully account for external constraints and
structural factors that may limit individuals' control over their behavior, such as economic
constraints or limited access to health insurance options. Also, critics suggest that the theory
does not adequately capture cultural and contextual influences on behavior (Esfandiar, Pearce,
Dowling & Goh, 2023).
The theory has been widely applied in health promotion and behavior change interventions. In
the context of health insurance demand in Nigeria, TPB can be used to understand the factors
that shape individuals' intentions to purchase health insurance. For example, attitudes towards
health insurance, social norms regarding insurance coverage, and perceived control over the
purchasing process can be examined among different socio-demographic groups. This
information can then inform targeted interventions to address specific barriers or leverage
facilitating factors to increase demand for health insurance.

34. 26
2.4 Empirical Review
Adebiyi and Adeniji (2021) assessed the utilization of health care and associated factors
amongst the federal civil servants using the NHIS in Rivers state. This was a descriptive cross-
sectional study using self-administered questionnaires. Data were collated and analyzed using
SPSS version 21.0. A Chisquare test was carried out. The level of Confidence was set at 95%,
and the P-value≤.05. Out of a total of 334 respondents, 280 (83.8%) were enrolled for NHIS,
203 (72.5%) utilized the services of the scheme. Most 181 (82.1%) of the respondents who
utilized visited the facility at least once in the preceding year. Although, 123 (43.9%) of the
respondents made payments at a point of access to health care services, overall there was a
reduction in out of pocket payment. Possession of NHIS card, the attitude of health workers,
and patients’ satisfaction were found to significantly affect utilization P≤.05. Regression
analysis shows age and income to be a predictor of utilization of the NHIS. Though utilization
is high, effort should be made to remove payment at the point of access and improving the
harsh attitude of some of the health workers.
Amiri, Kazemian, Motaghed and Abdi (2021) identified the factors considered as determinants
of HCE at the national level and to report their significance. This study reviewed the empirical
literature on determinants of HCE. Electronic databases including Scopus (Elsevier),
PubMed/Medline, and ISI (Web of Science) were searched to retrieve articles published until
November 2017. Thirty six primary articles met the eligibility criteria and were included in this
review. Based on the findings, a wide range of factors explaining HCE growth including socio-
demographic, economic, technological, environmental and lifestyle factors, factors associated
with the epidemiological transition and changing patterns of diseases, factors related to the
provision for health services, and factors concerning the administration and design of the health
sector. The review suggests the need for considering a wider range of issues while investigating
HCE drivers, thereby shifting from factors traditionally considered as drivers of HCE to other

35. 27
explaining elements that their effects on HCE growth has been rarely examined. Although the
trends and determinants of HCE have been widely examined in high-income countries, limited
number of studies have investigated the issue at the aggregate level in developing countries.
Alo, Okedo-Alez and Akamike (2020) assessed the determinants of willingness to participate
in health insurance amongst PLHIV in a tertiary hospital in South-East Nigeria. Methods: A
cross-sectional survey was conducted amongst 371 PLHIV on treatment at Federal Teaching
Hospital, Abakaliki, Nigeria, using a semi-structured, interviewer-administered questionnaire.
Chi-square test and logistic regression were conducted with SPSS version 20 at 5% level of
significance. Results: Respondents were mostly males (51.8%) with a mean age and monthly
income of 45.4 ± 10.3 years and $74.1 ± 42, respectively. Majority were willing to participate
(82.5%) and to finance health insurance (65.2%). The major reasons cited by those unwilling
to participate were poor understanding of how the system works and lack of regular source of
income. The predictors of willingness to participate were female gender (adjusted odds ratio
[AOR] = 2.9; 95% confidence interval [CI]: 1.6–5.7), being currently unmarried (AOR = 4.3;
95% CI: 2.3–7.8), being self-employed (AOR = 2.2; 95% CI: 1.2–3.9), having family size >5
(AOR = 3.1; 95% CI: 1.7–5.9) and having less than secondary school education (AOR = 4.3;
95% CI: 2.3–7.8). Conclusion: Majority of the respondents surveyed were willing to participate
in, and finance health insurance. Willingness to participate was more amongst vulnerable
subgroups (females, unmarried, self-employed, poorly educated and those with large family
size). We recommend the inclusion of health insurance in the care package of PLHIV.
Alipio and Pregoner (2020) evaluated the potential determinants of healthcare utilization
among senior citizens in Davao City, Philippines. Stratified sampling with proportional
allocation was employed to select 2,952 respondents. Data were collected using questionnaires.
Of the total sample, 61.0% consumed cigarettes at most two times per week, 70.0% drank
alcohol two to three times per week, and 78.3% performed an exercise at most one-time per

36. 28
week. Approximately 59.0% reported experiencing two to three symptoms of a disease;
however, 56.3% of the respondents utilized healthcare services at most four times for the past
six months. Most of the respondents were unaware that they automatically receive PhilHealth
coverage in accredited healthcare facilities in the Philippines. Multiple regression analysis
revealed that age, sex, family size, monthly income, geographical area, lifestyle factors, and
awareness of health insurance were significant determinants of healthcare utilization. The
findings revealed the impact of socio-demographic, lifestyle, and health insurance awareness
on healthcare utilization among senior citizens. Policymakers and local government units may
consider improving the capability for senior citizens to access health services, such as
providing health insurance awareness programs and developing health-promoting activities.
Ranabhat, Subedi and Karn (2020) identified the enrollment and dropout rates of health
insurance and its determinants in selected districts of Nepal. The study was conducted while
using a mixed method including both quantitative and qualitative approaches. Numerical data
related to enrollment and dropout rates were taken from Health Insurance Board (HIB) of
Nepal. For the qualitative data, three districts, Bardiya, Chitwan, and Gorkha of Nepal were
selected purposively. Enrollment assistants (EA) of social health insurance program were taken
as the participants of study. Focus group discussions (FGD) were arranged with the selected
EAs using specific guidelines along with unstructured questions. The findings of the study
suggested variation in enrollment and dropout of health insurance in the districts. Enrollment
coverage was 13,545 (1%), 249,104 (5%), 1,159,477 (9%) and 1,676,505 (11%) from 2016 to
2019 among total population and dropout rates were 9121(67%), 110,885 (44%) and 444,967
(38%) among total enrollment from 2016 to 2018 respectively. Of total coverage, more than
one-third proportion was subsidy enrollment—free enrollment for vulnerable groups. The
population characteristics of unwilling and dropout in social health insurance came from
relatively well-off families, government employees, businessman, migrants’ people, some

37. 29
local political leaders as well as the poor class families. The major determinants of poor
enrollment and dropout were mainly due to unavailability of enough drugs, unfriendly behavior
of health workers, and indifferent behavior of the care personnel to the insured patients in health
care facilities and prefer to take health service in private clinic for their own benefits. The long
maturation time to activate health service, limited health package and lack of copayment in
different types of health care were the factors related to inefficient program and policy
implementation.
Mhlanga and Garidzirai (2020) analysed the influence of racial differences in the demand for
public healthcare in South Africa, using the 2018 General Household Survey (GHS) data. This
was completed to understand if race still plays a role in access to healthcare in post-apartheid
South Africa. Logistic regression analysis revealed that race significantly explained the
variance in demand for public healthcare, with White populations having the lowest probability
of demand for public healthcare compared to other races. Consequently, the study noted that
racial differences still play a critical role in affording one access to healthcare after assessing
the situation obtaining in public healthcare. Therefore, the study recommends that the
government of South Africa should create policies that encourage equal access to basic services
in addressing racial inequality in the country.
Pinilla and López-Valcárcel (2020) used a longitudinal database from the Bank of Spain to
analyse the financial behaviour of approximately six thousand families per wave. The authors
used three waves (2008, 2011 and 2014). The authors estimated income and wealth semi-
elasticities of Voluntary Private Health Insurance (VPHI) in Spain considering personal and
family characteristics (age, sex, level of health, education, composition of the household), i.e.
changes in the probability of buying VPHI as result of 1% change in income or wealth. Cross-
sectional models suggest that the income effect on the probability of buying a VPHI increased
from 2008 to 2014. The positive impact was observed for, wealth. In 2008 a 1% increase in

38. 30
income is associated with an increase in the probability of having VPHI of 0.064 [95%-CI:
0.023; 0.104] - on the probability scale (0.1) – whereas in 2014, this effect is of 0.116 [95%-
CI, 0.094; 0.139]. In 2011 and 2014 the wealth effect is not significant at 5%. The estimation
of the longitudinal model leads to different results where both, income and wealth are
associated with non- significant results.
Ayanore, Pavlova, Kugbey, Fusheini, Tetteh, Ayanore, Akazili, Adongo and Groot (2019)
examined health insurance coverage, type of payment for health insurance and reasons for
being uninsured under the National Health Insurance Scheme in Ghana. The 2014 Ghana
Demographic Health Survey datasets with information for 9396 women and 3855 men were
analyzed. The study employed cross-sectional national representative data. The frequency
distribution of socio-demographics and health insurance coverage differentials among men and
women is first presented. Further statistical analysis applies a two-stage probit Hackman
selection model to determine socio-demographic factors associated with type of payment for
insurance and reasons for not insured among men and women under the National Health
insurance Scheme in Ghana. The selection equation in the Hackman selection model also
shows the association between insurance status and socio-demographic factors. About 66.0%
of women and 52.6% of men were covered by health insurance. Wealth status determined
insurance status, with poorest, poorer and middle-income groups being less likely to pay
themselves for insurance. Women never in union and widowed women were less likely to be
covered relative to married women although this group was more likely to pay NHIS premiums
themselves. Wealth status (poorest, poorer and middle-income) was associated with non-
affordability as a reason for being not insured. Geographic disparities were also found. Rural
men and nulliparous women were also more likely to mention no need of insurance as a reason
of being uninsured.

39. 31
Mirach, Demissie and Biks (2019) assessed factors that determine decisions to join the
community based health insurance in West Gojjam zone. A community based cross sectional
survey was conducted to collect data from 690 household heads using a multistage sampling
technique. A binary logistic regression was used to identify the determinants of household
decisions for CBHI enrollment. Out of the participants, 58% were CBHI members. Besides,
family size (AOR = 1.17; CI = 1.02–1.35), average health status (AOR = .380; CI = .179–.805),
chronic disease (AOR = 3.42; CI = 1.89–6.19); scheme benefit package adequacy
(AOR = 2.17; CI = 1.20–3.93), perceived health service quality (AOR = 3.69; CI = 1.77–7.69),
CBHI awareness (AOR = 4.90; CI = 1.65–14.4); community solidarity (AOR = 3.77;
CI = 2.05–6.92) and wealth (AOR = 3.62; CI = 1.67–7.83) were significant determinant factors
for enrolment in the community based health insurance scheme. CBHI awareness, family
health status, community solidarity, quality of service of health institutions, and wealth were
major factors that most determine the household decisions to enroll in the system. Therefore,
in-depth and sustainable awareness creation programs on the scheme; stratified premium-
based on economic status of households; incorporation of social capital factors, particularly
building community solidarity in the scheme implementation are vital to enhance sustainable
enrollment. As perceived family health status and the existence of chronic disease were also
found significant determinants of enrollment, the Government might have to look for options
to make the scheme mandatory.
Nsiah-Boateng, Nonvignon, Aryeetey, Salari, Tediosi, Akweongo and Aikins (2019) examined
policy design factors associated with enrolment and dropout of the scheme in an urban poor
district using routine secondary data. This study is a cross-sectional quantitative analysis of
2014–2016 NHIS enrolment data of the Ashiedu Keteke district office. Descriptive and
multivariate logistic regression analyses were performed to examine sociodemographic factors
associated with NHIS enrolment and dropout. A total of 215,724 individuals enrolled in the

40. 32
NHIS over the period under study, of which 98,232 (46%) were new members. About 41% of
existing members in 2014 dropped out of the NHIS in 2015 and 53% of those in 2015 dropped
out in 2016. The indigents (core poor) are significantly more likely to enroll and to drop out of
the NHIS. However, the males, informal sector employees, social security and national
insurance trust (SSNIT) contributors, and the aged (70+ years) are significantly less likely to
enroll in the NHIS but more likely to retain coverage.
Paul and Chouhan (2019) examined the socio-demographic factors of maternal health care
utilization among Indian women. A cross-sectional study was conducted using the data from
the 2015–2016 National Family Health Survey (NFHS-4) in India. A total of 190,898 ever-
married women who had at least one live birth in the past five years preceding the survey were
utilized for this study. Bivariate and multivariate analyses were performed for the analysis of
the data. The study indicated that educational attainment of women and household wealth status
are the most significant predictors of maternal health care utilization. Other important socio-
demographic factors include rural-urban residence, caste, religion, women's age, age at
marriage, exposure to mass media and region. In conclusion, the study found that socio-
demographic factors play a significant role in determining utilization of maternal health care
services in India. Therefore, policymaker and programme administrators should address socio-
economic and demographic vulnerabilities of women to improve the use of maternal health
care services, which eventually could reduce the risk of maternal morbidity and mortality.
Sari and Idris (2019) analyzed the determinants of Independent NHI ownership in Indonesia.
This study used cross-sectional design, and the data were derived from Indonesian Family Live
Survey (IFLS) 2014. 6,888 individuals aged ≥40 years were the sample of this study. To
analyze the data, chi-square analysis and logistic regression were used. Based on the analysis,
the proportion of respondent with Independent NHI is 16.6%. The ownership of independent
NHI is influenced by the following factors: age 40-55 (PR=1.72 95%CI 1.41-2.09, p-value

41. 33
<0.001), Sumatra Island (PR=7.67 95%CI 5.55-10.59 p-value<0.001), very rich (PR = 2.26
95%CI 1.85-2.75 p-value <0.001), history of chronic disease (PR=1.33 95%CI 1.15-1.53 p-
value<0.001), junior high school (PR = 2.21 95%CI 1.92-2.55 p-value<0.001), and urban
(PR=1.79 95%CI 1.57-2.04 p-value <0.001). Region is the most dominant variable related to
NHI ownership (p-value <0.001; Exp B= 7.03; 95% CI: 5.06-9.77). Independent NHI
membership has not been maximal, yet. To increase this participation, the Social Security
Administrator should approach each region with low NHI membership through promotion,
socialization, and education about registration and the benefits of independent NHI.

42. 34
CHAPTER THREE
METHODOLOGY
3.1 Introduction
In this chapter, the researcher discussed the blueprint for conducting the study. The chapter
unveiled the research design, the area of study, the population of the study, the sample size and
sampling technique, the research instrument, the validity and reliability of the research
instrument, the method of data administration, and the methods of data analysis.
3.2 Research Design
The researcher employs research design to explain the methods or techniques used in collecting
data for the research study. The researcher adopted the descriptive survey research design for
the study. The descriptive survey design involves conducting a primary survey to gather
information at the local level. The research design enables making inferences about certain
characteristics or behavior of the population under examination.
3.3 Population of the Study
The National Bureau of Statistics (2019) reported that Lagos State had the highest number of
rural dwellers in Nigeria, and Nwogu (2021) stated in an online report that approximately
1,263,279 Lagos residents are living in extreme poverty. However, the study targeted the
population of residents in Yaba, encompassing the total number of individuals in that area.
3.4 Sample Size and Sampling Techniques
The researcher purposively determined the sample size for the study to include a total of two-
hundred and fifty (250) respondents from Yaba LCDA. The researcher employed a simple

43. 35
random sampling technique to select the respondents, ensuring an equal and fair basis of
selection to avoid biasedness.
3.5 Research Instrument
The researcher chose to use a close-ended type of questionnaire as the research instrument for
the study. The questionnaire consisted of two main sections, namely Section A and Section B.
Section A gathered information regarding the demographic characteristics of the respondents,
while Section B collected the sincere responses of the participants regarding the posed
statement of questions. The questionnaire items were rated on a 5-point Likert scale, with
options ranging from strongly agree (5), agree (4), undecided (3), disagree (2), to strongly
disagree (1).
3.6 Validity and Reliability of Research Instrument
The research instrument's validity, which measures how accurately a test measures its intended
purpose, underwent testing by presenting it to the supervisor and several lecturers in actuarial
science and insurance fields to assess its construct and contents validity. The research
instrument's reliability, or its ability to consistently produce the same result with repeated use,
was determined using the internal consistency method, specifically Cronbach Alpha, to
establish the reliability percentage for the research instrument.
3.7 Method of Data Administration
The researcher administered the research instrument through an online survey. In this research,
the justification for using an online survey stems from several reasons. Online surveys offer
convenience and efficiency in collecting data, as they can be accessed and completed by
respondents at their convenience, aided by the widespread use of the internet and digital
devices. This mode eliminates the necessity of conducting face-to-face interviews or relying

44. 36
on paper-based surveys, which can consume time and require substantial logistical
arrangements. By utilizing an online survey, the researcher achieves flexibility and are able to
reach a larger pool of respondents, thereby enhancing the generalizability of the findings.
3.8 Method of Data Analysis
In analyzing the collected data, the researcher adopted both descriptive and inferential
statistics. Descriptive statistics, which encompassed percentages, frequency, mean, and
standard deviation, were used to analyze the demographic characteristics of the respondents
and provide answers to the research questions. On the other hand, inferential statistics, such as
the regression model and Analysis of Variance (ANOVA), were employed to test the research
hypotheses at a 5% level of significance.

45. 37
CHAPTER FOUR
DATA ANALYSIS AND PRESENTATION OF FINDINGS
4.1 Introduction
In this chapter, the data collected during the research is analyzed and interpreted. The
researcher employed descriptive statistics to showcase the socio-demographic characteristics
of the respondents and address the pertinent research questions. Additionally, multiple
regression analysis was employed to examine the research hypotheses. While the researcher
anticipated receiving two hundred and fifty (250) responses from the participants, only two
hundred and sixteen (216) responses were obtained in their entirety and with accuracy.
Consequently, the analysis presented below is based on these retrieved responses.
4.2 Distribution of Respondents
In this section, we conducted an analysis of the socio-demographic characteristics of the
participants. We described the respondents' biographical information using frequencies and
percentages. The personal details of the participants were categorized according to factors such
as gender, age, education, and so on.
Table 4.1: Socio-Demographic Characteristics of Respondents
Freq. (N) %
Gender Male 107 49.5%
Female 109 50.5%
Total 216 100.0%
Age 18 - 25 years 9 4.2%
26 - 35 years 51 23.6%
36 - 45 years 60 27.8%
46 years and above 96 44.4%
Total 216 100.0%
Educational Level None 2 0.9%
O'LEVEL/A'LEVEL 8 3.7%
Diploma 103 47.7%

46. 38
First Degree 47 21.8%
Post-Graduate Degree 54 25.0%
Others 2 0.9%
Total 216 100.0%
Occupation Unemployed 13 6.0%
Self-Employed 87 40.3%
Civil Servants 23 10.6%
Employees 41 19.0%
Business Owners 43 19.9%
Others 9 4.2%
Total 216 100.0%
Monthly Income Less than 100k 111 51.4%
100k - 300k 48 22.2%
300k - 500k 34 15.7%
Above 500k 23 10.6%
Total 216 100.0%
Source: Researcher’s Compilation (2023)
Table 4.1 presents the socio-demographic characteristics of the respondents in this research
study aiming to understand the factors influencing the demand for health insurance in Nigeria.
The table provides insights into the distribution of respondents based on gender, age,
educational level, occupation, and monthly income, along with the corresponding frequencies
and percentages. The table shows that the sample consists of a relatively equal representation
of male and female respondents, with 49.5% male and 50.5% female. This indicates a balanced
gender distribution within the sample.
In terms of age distribution, the largest proportion of respondents falls within the 46 years and
above category, accounting for 44.4% of the sample. The 36-45 years age group follows with
27.8%, while the 26-35 years and 18-25 years age groups constitute 23.6% and 4.2%,
respectively. This indicates that the majority of respondents are older individuals. Regarding
educational attainment, the table demonstrates that the largest proportion of respondents have
a diploma (47.7%), followed by post-graduate degree holders (25.0%) and individuals with a
first degree (21.8%). Only a small percentage of respondents have O'LEVEL/A'LEVEL

47. 39
qualifications (3.7%), while the remaining respondents have either no education or other
educational backgrounds.
In terms of occupation, the respondents' distribution reveals that self-employed individuals
constitute the largest group (40.3%), followed by business owners (19.9%) and employees
(19.0%). Civil servants account for 10.6% of the sample, while unemployed individuals
represent 6.0%. A small proportion falls into the "Others" category (4.2%). The table shows
the distribution of respondents based on their monthly income. Among the respondents, 51.4%
earns less than 100k monthly, 22.2% earns between 100k – 300k monthly, 15.7% earns
between 300k – 500k monthly, and 10.6% earns above 500k monthly. Notably, majority of the
respondents earns less than 100k monthly.
4.3 Analysis of Questionnaire Items
In this section, we thoroughly examined the pertinent research inquiries. We presented the
responses to each specific research question in an observational manner, outlining their
occurrences without any manipulation of the variables.
Table 4.2: Demand for Health Insurance Schemes in Nigeria
Strongly
Disagree Disagree Undecided Agree
Strongly
Agree Total
I would consider enrolling in NHIS to
ensure my healthcare needs are
covered.
Freq. (N) 3 7 11 85 110 216
% 1.4% 3.2% 5.1% 39.4% 50.9% 100.0%
I would be willing to pay for private
health insurance to have greater
control over my healthcare options.
Freq. (N) 15 16 11 58 116 216
% 6.9% 7.4% 5.1% 26.9% 53.7% 100.0%
I would prefer to work for an employer
that provides comprehensive health
insurance benefits.
Freq. (N) 29 24 24 53 86 216
% 13.4% 11.1% 11.1% 24.5% 39.8% 100.0%
I would consider joining a community-
based health insurance scheme to
support my local community.
Freq. (N) 30 30 13 61 82 216
% 13.9% 13.9% 6.0% 28.2% 38.0% 100.0%
Freq. (N) 26 26 7 61 96 216

48. 40
I would actively seek enrolment in a
state health insurance scheme if it
provides adequate coverage.
% 12.0% 12.0% 3.2% 28.2% 44.4% 100.0%
I would encourage educational
institutions to provide comprehensive
health insurance for their students and
staff.
Freq. (N) 56 13 10 56 81 216
% 25.9% 6.0% 4.6% 25.9% 37.5% 100.0%
I would be more likely to join a
professional association that offers a
social health insurance scheme.
Freq. (N) 46 32 8 61 69 216
% 21.3% 14.8% 3.7% 28.2% 31.9% 100.0%
I would prioritize obtaining
comprehensive family health insurance
coverage.
Freq. (N) 25 10 8 78 95 216
% 11.6% 4.6% 3.7% 36.1% 44.0% 100.0%
I would actively consider purchasing
voluntary health insurance to
supplement existing coverage.
Freq. (N) 22 21 14 74 85 216
% 10.2% 9.7% 6.5% 34.3% 39.4% 100.0%
I support the expansion of micro health
insurance schemes to reach more
underserved populations.
Freq. (N) 7 12 18 61 118 216
% 3.2% 5.6% 8.3% 28.2% 54.6% 100.0%
Source: Researcher’s Compilation (2023)
Table 4.2 provides information on the demand for health insurance schemes in Nigeria based
on the responses of the research participants. The table presents the frequency and percentage
of respondents for each statement related to health insurance. Majority of the respondents
(50.9%) strongly agree with enrolling in the National Health Insurance Scheme (NHIS) to
ensure their healthcare needs are covered; a significant portion (39.4%) also agree with this
statement, indicating a high level of interest in NHIS enrollment while a small percentage of
respondents (1.4%) strongly disagree or (3.2%) disagree.
A considerable number of respondents (53.7%) strongly agree with being willing to pay for
private health insurance for greater control over their healthcare options; additionally, 26.9%
agree with this statement while only a small percentage (6.9%) strongly disagree or (7.4%)
disagree. Nearly 39.8% of respondents strongly agree with the preference for working with
employers that offer comprehensive health insurance benefits; a significant portion (24.5%)

49. 41
also agree with this statement while some respondents (13.4%) strongly disagree or (11.1%)
disagree. A substantial number of respondents (38.0%) strongly agree with considering joining
a community-based health insurance scheme to support their local community; 28.2% agree
with this statement while a minority (13.9%) strongly disagree or (13.9%) disagree.
44.4% of respondents strongly agree with actively seeking enrollment in a state health
insurance scheme if it provides adequate coverage; a considerable portion (28.2%) agrees with
this statement while some respondents (12.0%) strongly disagree or (12.0%) disagree. Majority
of the respondents (37.5%) strongly agree with encouraging educational institutions to offer
comprehensive health insurance; 25.9% agree with this statement while some respondents
(25.9%) strongly disagree or (6.0%) disagree. A significant number of respondents (31.9%)
strongly agree with being more likely to join a professional association that offers a social
health insurance scheme; 28.2% agree with this statement while some respondents (21.3%)
strongly disagree or (14.8%) disagree.
44.0% of respondents strongly agree with prioritizing comprehensive family health insurance
coverage; a substantial portion (36.1%) agrees with this statement while some respondents
(11.6%) strongly disagree or (4.6%) disagree. 39.4% of respondents strongly agree with
actively considering purchasing voluntary health insurance to supplement existing coverage;
34.3% agree with this statement while some respondents (10.2%) strongly disagree or (9.7%)
disagree. Majority of the respondents (54.6%) strongly agree with supporting the expansion of
micro health insurance schemes to reach more underserved populations; 28.2% agree with this
statement while s small percentage (3.2%) strongly disagree or (5.6%) disagree.
The results indicate a significant level of interest and demand for various types of health
insurance schemes, including NHIS, private health insurance, community-based schemes, state
health insurance, and micro health insurance. Policymakers should capitalize on this demand

50. 42
and develop policies that cater to the specific preferences and needs of the population. The
preference for working with employers offering comprehensive health insurance highlights the
significance of employer-sponsored schemes. Policymakers could consider providing
incentives or regulations to encourage more employers to provide health insurance benefits to
their employees, promoting greater coverage and access.
The strong agreement regarding comprehensive family health insurance coverage suggests the
importance of prioritizing family healthcare needs. Policymakers can focus on developing
policies that promote and facilitate affordable and comprehensive family health insurance
plans. Respondents' positive attitudes towards community-based and micro health insurance
schemes indicate the need for expanding these programs to reach underserved populations.
Policymakers should consider supporting and incentivizing the growth of such schemes,
particularly in rural and economically disadvantaged areas, to ensure equitable access to
healthcare services.
The willingness to join professional associations with social health insurance schemes and the
support for comprehensive health insurance in educational institutions suggest the potential for
collaborations between these entities and health insurance providers. Policymakers can explore
partnerships and initiatives that leverage these organizations to expand health insurance
coverage and improve access. Overall, policymakers should consider the demand patterns
observed in the study while formulating policies and strategies to improve access and uptake
of health insurance schemes in Nigeria.
4.4 Tests of Hypotheses
Multiple regression analysis was employed to test the research hypotheses using the Statistical
Package for Social Sciences (SPSS), with a significance level set at 5%. The decision rule states

51. 43
that if the significance level exceeds 5%, the null hypotheses will be accepted; otherwise, they
will be rejected.
Table 4.3: Model Summary
Model R R Square Adjusted R Square
Std. Error of the
Estimate Durbin-Watson
1 .386a
.149 .129 .61412 2.178
a. Predictors: (Constant), Monthly Income, Gender, Occupation, Educational Level, Age
b. Dependent Variable: Demand for Health Insurance Schemes in Nigeria
Source: Researcher’s Compilation (2023)
Table 4.3 presents the model summary of this research study, which aims to provide insights
into the socio-demographic variables that influence the demand for health insurance in Nigeria.
The table includes information about the goodness of fit of the regression model and the
predictors used in the analysis. The coefficient of determination (R Square) is 0.149, indicating
that approximately 14.9% of the variance in the demand for health insurance schemes in
Nigeria can be explained by the socio-demographic variables included in the model. The
correlation coefficient (R) is 0.386, suggesting a weak positive correlation between the
predictors and the demand for health insurance.
The adjusted R Square is 0.129, which takes into account the number of predictors and adjusts
the R Square value accordingly. It indicates that approximately 12.9% of the variance in the
demand for health insurance is explained by the socio-demographic variables, considering the
model's complexity. The standard error of the estimate is 0.61412, representing the average
distance between the actual demand for health insurance and the predicted values by the model.
A lower value indicates a better fit of the model to the data. The Durbin-Watson statistic is
2.178, which measures the presence of autocorrelation (correlation between error terms) in the
model. A value close to 2 suggests no significant autocorrelation.
The model summary provides some insights into the relationship between socio-demographic
variables and the demand for health insurance in Nigeria. However, the low R Square value

52. 44
suggests that these variables explain only a small proportion of the variation in the demand
for health insurance. Therefore, further analysis and exploration of additional factors are
necessary to gain a more comprehensive understanding.
Table 4.4: Analysis of Variance (ANOVA)
Model Sum of Squares Df Mean Square F Sig.
1 Regression 13.901 5 2.780 7.372 .000b
Residual 79.199 210 .377
Total 93.100 215
a. Dependent Variable: Demand for Health Insurance Schemes in Nigeria
b. Predictors: (Constant), Monthly Income, Gender, Occupation, Educational Level, Age
Source: Researcher’s Compilation (2023)
Table 4.4 presents the analysis of variance (ANOVA) results for the regression model used in
the research study, which aims to analyze the socio-demographic variables influencing the
demand for health insurance schemes in Nigeria. The table provides information about the sum
of squares, degrees of freedom (df), mean square, F-statistic, and the significance level (p-
value) associated with the model. The sum of squares for the regression model is 13.901,
indicating the amount of variation in the dependent variable (demand for health insurance) that
is explained by socio-demographic variables (monthly income, gender, occupation, educational
level, and age).
The model has 5 degrees of freedom, corresponding to the number of predictors used in the
analysis. The mean square is 2.780, which is obtained by dividing the sum of squares by the
degrees of freedom. The sum of squares for the residual, also known as the error term, is 79.199.
It represents the unexplained variation in the dependent variable after accounting for the
predictors. The model has 210 degrees of freedom for the residual, indicating the number of
data points minus the number of predictors. The total sum of squares is 93.100, which
represents the total variation in the dependent variable without considering the predictors. The
F-statistic is 7.372, calculated by dividing the mean square of the regression by the mean square

53. 45
of the residual. It determines the overall significance of the regression model. The associated
significance level (p-value) is .000, which indicates that the F-statistic is statistically significant
at conventional significance levels (e.g., p < .05).
The ANOVA results indicate that the regression model, using the socio-demographic variables
as predictors, has a statistically significant overall relationship with the demand for health
insurance schemes in Nigeria. That is, we reject the null hypotheses six (HO6) and accept the
alternate hypothesis that there is a significant relationship between socio-demographic
variables and the demand for health insurance schemes in Nigeria. However, it is important to
note that the model explains only a portion of the total variation in the demand for health
insurance, as evidenced by the relatively small sum of squares for the regression compared to
the total sum of squares.
Table 4.5: Coefficients
Model
Unstandardized
Coefficients
Standardized
Coefficients
t Sig.
Collinearity Statistics
B Std. Error Beta Tolerance VIF
1 (Constant) 3.236 .218 14.875 .000
Gender -.010 .158 -.008 -.063 .950 .278 3.592
Age .193 .085 .269 2.270 .024 .289 3.455
Educational Level .128 .062 .184 2.055 .041 .504 1.984
Occupation -.099 .039 -.212 -2.539 .012 .583 1.716
Monthly Income -.075 .041 -.119 -1.834 .068 .960 1.041
a. Dependent Variable: Demand for Health Insurance Schemes in Nigeria
Source: Researcher’s Compilation (2023)
Table 4.5 presents the coefficients of the regression model used to evaluate the null hypotheses
related to the demand for health insurance schemes in Nigeria. The table provides information
about the unstandardized coefficients, standardized coefficients, t-values, significance levels
(p-values), and collinearity statistics for each predictor variable. The constant term is 3.236,
representing the estimated intercept of the regression model. It indicates the expected value of
the demand for health insurance when all predictor variables are set to zero.

54. 46
The coefficient for gender is -0.010, indicating a negligible negative association between
gender and the demand for health insurance schemes in Nigeria. The standardized coefficient
(beta) is -0.008, which suggests that gender has a minimal impact on the demand for health
insurance after considering the scale of other predictors. The t-value is -0.063, and the
associated p-value is 0.950, indicating that gender is not statistically significant in predicting
the demand for health insurance.
The coefficient for age is 0.193, indicating a positive relationship between age distribution and
the demand for health insurance schemes in Nigeria. The standardized coefficient (beta) is
0.269, suggesting that age has a moderate influence on the demand for health insurance after
considering the scale of other predictors. The t-value is 2.270, and the associated p-value is
0.024, indicating that age is statistically significant in predicting the demand for health
insurance.
The coefficient for educational level is 0.128, suggesting a positive relationship between
educational distribution and the demand for health insurance schemes in Nigeria. The
standardized coefficient (beta) is 0.184, indicating that educational level has a moderate impact
on the demand for health insurance after considering the scale of other predictors. The t-value
is 2.055, and the associated p-value is 0.041, indicating that educational level is statistically
significant in predicting the demand for health insurance.
The coefficient for occupation is -0.099, indicating a negative association between
occupational distribution and the demand for health insurance schemes in Nigeria. The
standardized coefficient (beta) is -0.212, suggesting that occupation has a moderate influence
on the demand for health insurance after considering the scale of other predictors. The t-value
is -2.539, and the associated p-value is 0.012, indicating that occupation is statistically
significant in predicting the demand for health insurance.