Awareness, willingness, and challenges of the informal sector toward state National Health Insurance Services in Benin City, Nigeria

Background: As access to vital health services expands and universal health coverage is attained, health insurance is projected to serve as a critical risk protection for families and small enterprises. Aim: To assess the informal sector's awareness, willingness, and problems in enrolling in the state national health insurance program. Materials and Methods: This cross-sectional descriptive study was done in Benin City, Nigeria, in the unorganized sector. A self-structured questionnaire was created, distributed, and retrieved for this study, which was conducted among 155 artisans chosen through a stratified random sample procedure. To evaluate the data, Statistical Package for the Social Sciences, SPSS version 22 was used. Results: In total, 138 people (89.0%) are aware of the National Health Insurance Scheme (NHIS), while only 93 people (60.0%) know that Edo state has a state-owned Health Insurance Scheme (SHIS). Only 17 people, or 11.0%, are engaged in the NHIS/SHIS program, whereas 107 people, or 77.5%, have expressed interest. Lack of accessibility to authorized healthcare facilities near house 22 (71.0%) is a significant deterrent to enrollment in the program. Long lines at service points (3.88, 1.093), the time it takes to enroll new members in the program (3.78, 1.101), the time it takes for health maintenance organizations to issue authorization codes (3.62, 1.316), the accessibility of NHIS services outside of registration institutions (3.29, 1.289), and the standard of drugs provided by the SHIS (3.12, 1.358) are all factors that hinder utilization. Sex and place of residence each strongly correlated with readiness to sign up for the program (AOR = 4.234, P = 0.017, 95% CI: 1.293-13.873 and AOR = 5.224, P = 0.007, 95% CI: 1.557-17.530, respectively). Conclusion: The artisans have a low rate of health insurance coverage but are eager to sign up for the program. State policymakers should increase their reach and make enrollment required to attain a higher range.