Assessment of the Impact of Health Maintenance Organizations on Access, Utilization, and Quality of Service among National Health Insurance Authority Enrollees in Kano, Kano State Nigeria

Abstract

Effort by government in Nigeria to provide effective ways of accessing quality and affordable healthcare service has been contentious with high cost of health care service delivery. The ineffective management of health care funds over the years was observed as key contributor to the rising cost of healthcare services. The need for the establishment of health maintenance organizations (HMOs) whose responsibility as purchasers, was to manage health care services with health facilities providers under the National Health Insurance Authority Scheme (NHIA). However, this research seeks to assess the impact of healthcare purchasers in Kano state Nigeria, as regards knowledge, utilization, and satisfaction of enrollees whose healthcare services they manage. The study utilized analysis of enrollees, HMOs and desk officers under the scheme. Quantitative and qualitative methods using interviewer administered questionnaire and Key stakeholders’ interview was used. Data were recorded in Microsoft Excel 2010 and analyzed using SPSS version 23.0. NVIVO version 12 with verbatim transcription was used for thematic analysis of qualitative data. Chi-square used to test degree of association and Logistic regression utilized to predict factors for the determinants. Results were presented as tables and charts. Statistical significance p-value <0.05 at confidence level of 95% was considered significant. Thus, analysis of the general demographic outcomes showed a significant association between HMOs and enrollees’ level of knowledge, utilization and satisfaction (p<0.05). Conversely, analysis of federal, state and private run facilities separately, revealed varying outcome as regards the three determinants, with the state-run hospitals mostly affected in terms of enrollee’s outcome. Keywords: Desk officers, Health Maintenance Organizations, Knowledge, National Health Insurance Authority, Satisfaction, Utilization.