INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities , improve financial protection and improve health status , although findings are not totally consistent .
BACKGROUND Exp and ing public health insurance seeks to attain several desirable objectives , including increasing access to healthcare services , reducing the risk of catastrophic healthcare expenditures , and improving health outcomes .
The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years .
Effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria: a population-based study.
IMPORTANCE Hypertension is a major public health problem in sub-Saharan Africa , but the lack of affordable treatment and the poor quality of health care compromise antihypertensive treatment coverage and outcomes . OBJECTIVE To report the effect of a community-based health insurance ( CBHI ) program on blood pressure in adults with hypertension in rural Nigeria . DESIGN , SETTING , AND PARTICIPANTS We compared changes in outcomes from baseline ( 2009 ) between the  CBHI program  area and a control area in 2011 through consecutive household surveys . Households were selected from a stratified r and om sample of geographic areas . Among 3023 community-dwelling adults , all nonpregnant adults ( aged ≥18 years ) with hypertension at baseline were eligible for this study . INTERVENTION Voluntary CBHI covering primary and secondary health care and quality improvement of health care facilities . MAIN OUTCOMES AND MEASURES The difference in change in blood pressure from baseline between the program and the control areas in 2011 , which was estimated using difference-in-differences regression analysis . RESULTS Of 1500 eligible households , 1450 ( 96.7 % ) participated , including 564 adults with hypertension at baseline ( 313 in the program area and 251 in the control area ) . Longitudinal data were available for 413 adults ( 73.2 % ) ( 237 in the program area and 176 in the control area ) . Baseline blood pressure in respondents with hypertension who had incomplete data did not differ between areas . Insurance coverage in the hypertensive population increased from 0 % to 40.1 % in the program area ( n = 237 ) and remained less than 1 % in the control area ( n = 176 ) from 2009 to 2011 . Systolic blood pressure decreased by 10.41 ( 95 % CI , -13.28 to -7.54 ) mm Hg in the program area , constituting a 5.24 ( -9.46 to -1.02)-mm Hg greater reduction compared with the control area ( P = .02 ) , where systolic blood pressure decreased by 5.17 ( -8.29 to -2.05 ) mm Hg . Diastolic blood pressure decreased by 4.27 ( 95 % CI , -5.74 to -2.80 ) mm Hg in the program area , a 2.16 ( -4.27 to -0.05)-mm Hg greater reduction compared with the control area , where diastolic blood pressure decreased by 2.11 ( -3.80 to -0.42 ) mm Hg ( P = .04 ) . CONCLUSIONS AND RELEVANCE Increased access to and improved quality of health care through a CBHI program was associated with a significant decrease in blood pressure in a hypertensive population in rural Nigeria .  Community-based health insurance programs should be included in strategies to combat cardiovascular disease in sub-Saharan Africa
INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities , improve financial protection and improve health status , although findings are not totally consistent .
BACKGROUND Exp and ing public health insurance seeks to attain several desirable objectives , including increasing access to healthcare services , reducing the risk of catastrophic healthcare expenditures , and improving health outcomes .
The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years .