RESEARCH ARTICLE Determinants and perception of health insurance participation among healthcare providers in Nigeria: A mixed-methods study Hezekiah Olayinka Shobiye ID 1,2 *, Ibironke Dada 3 , Njide Ndili 3 , Emmanuella Zamba 4 , Frank Feeley 2 , Tobias Rinke de Wit 5,6 1 John F. Kennedy School of Government, Harvard University, Cambridge, MA, United States of America, 2 Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America, 3 PharmAccess Foundation, Lagos, Nigeria, 4 Lagos State Health Management Agency, Lagos, Nigeria, 5 PharmAccess Group and Joep Lange Institute, Amsterdam, Netherlands, 6 Amsterdam Institute of Global Health and Development, Amsterdam, Netherlands * hoshobiye@gmail.com Abstract Background To accelerate universal health coverage, Nigeria’s National Health Insurance Scheme (NHIS) decentralized the implementation of government health insurance to the individual states in 2014. Lagos is one of the states that passed a State Health Insurance Scheme into law, in order to expand the benefits of health insurance beyond the few residents enrolled in community-based health insurance programs, commercial private health insurance plans or the NHIS. Public and private healthcare providers are a critical component of the Lagos State Health Scheme (LSHS) rollout. This study explored the determinants and perception of provider participation in health insurance programs including the LSHS. Methods This study used a mixed-methods cross sectional design. Quantitative data were collected from 60 healthcare facilities representatively sampled from 6 Local Government Areas in Lagos state. For the qualitative data, providers were interviewed using structured question- naires on selected characteristics of each health facility in addition to the managers’ opin- ions about the challenges and benefits of insurance participation, capacity pressure, resource availability and financial management consequences. Results A higher proportion of provider facilities participating in insurance relative to non-participat- ing facilities were larger with mid to (very) high patient volume, workforce, and longer years of operation. In addition, a greater proportion of private facilities compared to public facilities participated in insurance. Furthermore, a higher proportion of secondary and tertiary facili- ties relative to primary facilities participated in insurance. Lastly, increase in patient volume and revenue were motivating factors for provider facilities to participate in insurance, while PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0255206 August 4, 2021 1 / 20 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Shobiye HO, Dada I, Ndili N, Zamba E, Feeley F, de Wit TR (2021) Determinants and perception of health insurance participation among healthcare providers in Nigeria: A mixed-methods study. PLoS ONE 16(8): e0255206. https://doi.org/ 10.1371/journal.pone.0255206 Editor: Kingston Rajiah, International Medical University, MALAYSIA Received: November 8, 2020 Accepted: July 13, 2021 Published: August 4, 2021 Copyright: © 2021 Shobiye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: The Netherlands Ministry for Foreign Trade and Development Cooperation through PharmAccess Foundation (https://www. pharmaccess.org) provided travel and logistics support to HOS during data collection. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.