Abstract
BackgroundTo improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. The NHIS remains Nigeria’s leading vehicle for achieving universal health coverage; nonetheless, questions remain regarding its quality and effectiveness. Studies on patient satisfaction have served as a useful strategy to further understand the patient experience and the efficacy of health systems.AimTo synthesise current knowledge on patient satisfaction with the NHIS.MethodsThe authors performed a systematic review of primary literature from 1999 to 2020 reporting on NHIS patient satisfaction in eight databases (including PubMed, Embase, and Africa-wide Information).ResultsThis search returned 764 unique records of which 21 met criteria for full data extraction. The 21 qualifying studies representing 11 of the 36 Nigerian states, were published from 2011 to 2020, and found moderate overall satisfaction with the NHIS (64%). Further, when disaggregated into specific domains, NHIS enrolees were most satisfied with provider attitudes (77%) and healthcare environments (70%), but less satisfied with laboratories (62%), billings (62%), pharmaceutical services (56%), wait times (55%), and referrals (51%). Importantly, time trends indicate satisfaction with the NHIS is increasing – although to differing degrees depending on the domain.ConclusionThe beneficiaries of the NHIS are moderately satisfied with the scheme. They consider it an improvement from being uninsured, but believe that the scheme can be considerably improved. The authors present two main recommendations: (1) shorter wait times may increase patient satisfaction and can be a central focus in improving the overall scheme, and (2) more research is needed across all 36 states to comprehensively understand patient satisfaction towards NHIS in anticipation of potential scheme expansion.
Highlights
Lack of access to healthcare and unaffordable healthcare, remain major sources of hardship for households across the world
As a result of the extreme burden related to healthcare costs, universal health coverage (UHC) has been included amongst the World Health Organization (WHO) 2030 Sustainable Development Goals (SDGs).[1]
Studies examining the satisfaction of patients with the Nigerian Health Insurance Scheme (NHIS were identified by searching the electronic databases PubMed (National Center for Biotechnology Information [NCBI]), Embase (Elsevier), Web of Science Core Collection (Clarivate), Global Index Medicus (World Health Organization [WHO]), EconLit (ProQuest), PAIS Index (ProQuest), Africa-wide Information
Summary
Lack of access to healthcare and unaffordable healthcare, remain major sources of hardship for households across the world. According to The World Health Organization (WHO), nearly 100 million people are being pushed into extreme poverty as a result of medical bills and over 930 million people spend 10% or more of their household income on healthcare services.[1] As a result of the extreme burden related to healthcare costs, universal health coverage (UHC) has been included amongst the WHO 2030 Sustainable Development Goals (SDGs).[1] The WHO advocated that member states pursue compulsory health insurance, more equitable tax systems, or a combination, as a path to reduce direct payments and user fees for health services.[2] Towards the end of the 20th century, many African nations began initiating such reforms. To improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. Studies on patient satisfaction have served as a useful strategy to further understand the patient experience and the efficacy of health systems
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