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Objective: To determine the predictors of payment methods for health care, perception and use of National health insurance scheme (NHIS) among pregnant women in a low income country.  Methods: An adapted, pretested, semi-structured, interviewer administered questionnaire was used to collect data from 770 pregnant women attending antenatal care (ANC) services in the two selected tertiary health institutions in south-east Nigeria. All consenting pregnant women attending ANC in the facilities irrespective of age and reason for visit were included. Data analysis was by SPSS version 25. Logistic regression model was used to predict the factors influencing perception and use of NHIS. Statistical significance was accepted when P- value was <0.05.  Results: Up to 70.9% of the respondents pay for health care out of their pockets for health services while only 20.0% use the NHIS. Fifty-two percent practice a monthly budget while 67.0% were aware of NHIS. The women had varied perceptions and concerns about NHIS which ranged from inability of the scheme to cover healthcare costs, and reduce hardships from high cost of health care to use of poor quality drugs. Eight (5.2%) of the 154 women that registered with the scheme had never used it. There were statistically significant association between level of education (x2= 107.7, p<0.001), respondents’ occupation (x2=49.6, p<0.001), respondents’ spouse occupation (x2=103.3, p<0.001), monthly income (x2=55.0, p<0.001) as well as age of the respondent (x2=8.2, p=0.004) and the awareness of NHIS in both facilities. Respondents aged less than 39 years were 0.46 times less likely to use NHIS compared to those 39 years and above (AOR=0.46, p< 0.022, 95%CI = 0.236 –0.900). Use of NHIS was significantly associated with educational level (x2=19.0, p<0.001) and occupation of spouse (x2=24.0, p<0.001) in both facilities. There was a significant difference in the method of use of NHIS between the two hospitals (x2=14.83, p<0.001).  Conclusion: Majority of pregnant women still pay for health care by out-of-pocket method and awareness about the NHIS was fair and a good number of the women were willing to enrol in the scheme if offered the opportunity. Significant predictors for NHIS use were maternal age, occupation of spouse and income.

Predictors of Payment Methods for Health Care, Perception and Use of the National Health Insurance Scheme among Pregnant Women in Nigeria