Abstract
BackgroundIn Nigeria, health maintenance organizations (HMOs) are the purchasers of health insurance with a social National Health Insurance Scheme for civil servants. However the roles of HMOs in implementation of social health insurance are not clear. This study determined the roles of HMOs in implementation of the national social health insurance scheme in Enugu, Southeast Nigeria.MethodsA partially mixed sequential dominant status design was employed in the study. Quantitative data were collected from 613 Federal Government employees that are registered with the National Health Insurance Scheme (NHIS) as part of the Formal Sector Social Health Insurance Program (FSSHIP) using an interviewer-administered questionnaire. Test for sampling adequacy was ensured (KMO, 0.701) and likewise the sphericity of the data using Bartlett’s test (Chi [1] 796.72, p-value < 0.001). For the qualitative study, there was document review and in-depth interviews. A total of 28 in-depth interviews were conducted with key stakeholders comprising of managers of HMOs, NHIS manager, providers of health care and personnel in the State Ministry of Health among others. Thematic analysis was used for the qualitative data.ResultsOne-third (31.5%) of respondents said that roles of HMOs were very important, while 23% said that their roles were not important. More than half (57.70%) ranked HMOs very low in their roles, while 24.10% ranked them highest. Concentration index shows that the poor were satisfied (−.10), while the rich were highly satisfied (0.13) with roles of HMOs. The qualitative data analysis showed that most of the respondents were not satisfied with the roles of HMOs based on the themes that were developed and analyzed.ConclusionThere is clear understanding of the functions of HMOs among respondents in the study although they generally think that HMOs are not meeting the expectations of the scheme. There is need for the Federal Government through the National Health Insurance Scheme to provide more effective guidelines for HMOs, supervise and monitor the implementation of such guidelines for HMOs to improve on their roles.
Highlights
In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insurance with a social National Health Insurance Scheme for civil servants
The questions that come to mind are, do HMOs perform their roles ? Are they acquainted with their responsibilities? Do HMOs aim at ensuring that stakeholders are satisfied with their roles? This study examined stakeholders’ satisfaction with the roles of HMOs in social health insurance implementation in Enugu, Southeast Nigeria
This study focused on civil servants because they are the only people that are presently fully covered by the Formal Sector Social Health Insurance Program (FSSHIP) of the National Health Insurance Scheme (NHIS)
Summary
In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insurance with a social National Health Insurance Scheme for civil servants. The roles of HMOs in implementation of social health insurance are not clear. This study determined the roles of HMOs in implementation of the national social health insurance scheme in Enugu, Southeast Nigeria. Health Maintenance Organizations (HMOs) purchase care on behalf of the National Health Insurance of USA [2]. With the formation of the National Health Insurance Scheme (NHIS) [1], private entities were encouraged to form HMOs [3]. Policy makers in health suggested a system of health insurance with HMOs participating as agents of the NHIS to purchase health services from public and private providers. HMOs are private sector driven and are expected to close leakages that might be arising from poor management by the public sector [4, 5]
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