Appraisal of Health Maintenance Organisations' Performance in the Nigerian Healthcare Service Sector.

Muideen O. Aremu,Eniola A. Sokefun,James O. Akinbode

doi:10.1155/2019/6820609

Abstract

The quality of healthcare service delivery under the existing health maintenance organisations (HMOs) in Nigeria has been a major concern to enrollees who have contested the value received from their respective HMO accredited hospitals under the program. This paper appraised health maintenance organisations' performance in the Nigerian healthcare service sector capturing enrollees' experience on the issues of access, responsiveness, and quality of healthcare service choice to measure the success or failure of the program since inception. The study adopted survey design with three hundred forty enrollees of ten leading HMOs in Nigeria that operate in different parts of Lagos Metropolis. Data collected were analysed with relevant descriptive and inferential statistics while hypotheses tested were at 0.05 level of significance. Findings revealed that HMO accredited hospitals have not ensured adequate access of enrollees to healthcare services, their responsiveness to enrollees' healthcare requests have not been impressive, and quality of healthcare services to enrollees have also not been excellent. Based on the findings, the study recommends that HMOs and government should improve on monitoring the quality of healthcare service delivery at their accredited hospitals and concluded that the performance of the HMOs in the area of healthcare service delivery is not world class when it comes to access, responsiveness, and quality of service delivery.

Highlights

Good health remains one of the basic needs of individual irrespective of status in the society. is is the reason why government as a major stakeholder in any society considers the issue of health as critical and fundamental
One of the healthcare intervention programs in Nigeria was the introduction of National Health Insurance Scheme (NHIS) backed with Act 35 of 1999 under which Health Maintenance Organisation (HMO) was set out to address observed short fall in the quality of healthcare service delivery. e scheme is jointly financed by employer and employee who is an enrollee. e health maintenance organisations (HMOs) model was borrowed from developed countries and treated as limited liability companies
In Nigeria, HMOs are licensed by the National Health Insurance Scheme (NHIS) to facilitate the provision of healthcare benefits to contributors

Summary

Introduction

Good health remains one of the basic needs of individual irrespective of status in the society. is is the reason why government as a major stakeholder in any society considers the issue of health as critical and fundamental. Government in different countries has different programs and policies to deliver qualitative healthcare system to her citizenry. In spite of the importance of a healthy living to society, accessing goodquality healthcare services has been incredibly poor in developing countries [3, 4]. One of the healthcare intervention programs in Nigeria was the introduction of National Health Insurance Scheme (NHIS) backed with Act 35 of 1999 under which Health Maintenance Organisation (HMO) was set out to address observed short fall in the quality of healthcare service delivery. E HMO model was borrowed from developed countries and treated as limited liability companies. In Nigeria, HMOs are licensed by the National Health Insurance Scheme (NHIS) to facilitate the provision of healthcare benefits to contributors

Methods

Results

Discussion

Conclusion