Households' health insurance status and COVID-19 vaccination in Nigeria: A recursive bivariate probit and decomposition estimation

Health insurance remains a viable option for the promotion of healthcare service utilization and efficiency. Very few studies have analyzed the linkages between health insurance uptake and COVID-19 vaccination decisions. This paper contributes to existing literature by recursively analyzing the effect of health insurance uptake on COVID-19 vaccination status in Nigeria. The data were the second wave of the National Longitudinal Phone Survey (NLPS), comprising 2750 respondents. The data were analyzed with the recently developed Recursive Bivariate Probit and Decomposition Estimation approach. The results showed that 31.50% and 7.78% were vaccinated and health insured, respectively. Health insurance was positively and significantly influenced (p<0.05) by being from the North West zone, urban residence, needing non-COVID maternal health, and adults or households' heads as the major vaccination decision makers. In addition, being vaccinated or having a vaccinated households' member was negatively and significantly influenced by three zonal variables (North East, North West, and South East) and urban residence, but positively influenced by age, needing COVID-19 related health services, concurring with making the vaccines mandatory and adults being the major vaccination decision makers. Health insurance recursively influenced being vaccinated or having a vaccinated households' member with significant positive treatment effects (p<0.05). It was concluded that efforts to promote health insurance will facilitate acceptability of COVID-19 vaccines. In addition, uptake of health insurance and COVID-19 vaccination can be enhanced with proper focus on some peculiar zonal and sectoral factors through initiatives that target adult households' members.