National Health Insurance Scheme Enrollees Research Articles

NATIONAL HEALTH INSURANCE SCHEME: A MEANS TO EFFECTIVE STROKE PREVENTION AMONG HYPERTENSIVES IN SUBSAHARAN AFRICA

<h2>ABSTRACT</h2><h3>Background and Aims</h3> Uncontrolled hypertension is a leading cause of stroke in Sub-Saharan Africa. Factors affecting blood pressure control include low income, sedentary lifestyle and unhealthy diet. We sought to determine the role of National Health Insurance Scheme (NHIS) in achieving good blood control among hypertensives in Ghana and Nigeria and thus prevention of stroke and other cardiovascular complications of uncontrolled hypertension. <h3>Methods</h3> A hospital-based descriptive cross-sectional study of 206 adult hypertensives systematically selected from 4 hospitals in Ghana (Adabraka and Maproby Polyclinics) and Nigeria (Ekiti State University Teaching Hospital, Ado-Ekiti and Federal Teaching Hospital, Ido-Ekiti). Patients were interviewed and physically examined and information entered into a questionnaire and analysed using SPSS 21. Informed consent was obtained from respondents and ethical approval obtained from all the four institutions. <h3>Results</h3> Respondents were mostly middle aged 113 (54.8%) with a mean age of 57±14; females 134 (65.5%); married 132 (64.1%) and NHIS enrollees 108 (52.4%). Majority of respondents had poor BP control 122 (59.2%). There was a significantly better blood pressure control among respondents from Ghana (OR 5.526; CI 3.006 to 10.161) and those on NHIS (OR 3.516; CI 1.946 to 6.352). <h3>Conclusions</h3> Out of pocket spending is a major cause of poor Blood Pressure control with predisposition to stroke. Universal Health Coverage through enrolment of all citizens under the NHIS scheme would provide standard healthcare to citizens irrespective of their income levels and help in blood pressure control and in turn prevent stroke in these patients.

Relationship between knowledge, attitude and practice of adults to the National Health Insurance Scheme and their health seeking behaviour in Unguwar soya, Kabong ward of Jos north LGA, Plateau state-Nigeria

Background: Health seeking behaviour includes all those behaviour associated with establishing and retaining a healthy state, plus aspects of dealing with the departure from that state, which can generally be improved by health care financing and insurance. The objective of the study was to evaluate the knowledge, attitude and practice of National Health Insurance Scheme (NHIS) of the people of Unguwar soya community and its relationship to their health seeking behaviour.Methods: The study one was a cross sectional community based descriptive study carried out using a multi stage sampling process in Unguwar soya community, Plateau state, Nigeria. An interviewer administered structured questionnaire was utilized and administered to 252 eligible respondents for a period of 3 months (September-November, 2019).Results: Majority of the respondents were aged 20-29 years (33.7%), females (63.5%), with majority earning above 30,000 naira (25.8%). Most respondents (59.5%) had heard about NHIIS. Most (70.7%) had good attitude towards NHIS and had the desire to enroll under NHIS (70.3%), mostly because of Subsidization of health care cost. Only 13.3% of the respondents are registered with NHIS. The most of the population visit chemist shops when ill (31.2%), however, majority of NHIS enrollees go to hospitals to seek care. None of those enrolled go to health centers, pharmacies, and home of health workers. 90.1% agreed that their health seeking behaviour will improve if enrolled under NHIS.Conclusions: Index population has inadequate awareness and low practice of the NHIS also with long run impact on the health seeking behaviour of residents of Unguwar soya community.

Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria.

Perceived quality of care is a determinant of uptake of health services. This study aimed to assess the determinants of quality of care of enrollees in the National Health Insurance Scheme (NHIS) in Nigeria. The outcome was satisfaction with health care services, which was used as a proxy for quality. Findings will assist in the intervention to enhance enrollment in the scheme and for universal health coverage attainment. This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in Ibadan, Nigeria. Data on satisfaction with health care were collected among selected 432 enrollees with the aid of an adapted semi-structured WHO-USAID interviewer-administered questionnaire. Data were analyzed using chi-square and multiple logistic regression models (α = 0.05). Among predictors of satisfaction with health services were younger age (OR = 1.85, 95% CI = 1.05–3.25, p = .024), working in the private sector (OR = 1.84, 95% CI = 1.03–3.28, p = .022), and seeking information about quality of services prior enrollment (OR = 1.63, 95% CI = 1.04−2.53, p = .013). Targeted intervention based on the findings of this study should be implemented to improve satisfaction with the services offered.

National Health Insurance Scheme Services and Patient Satisfaction: The Nigerian Experience

Healthcare delivery in the present day involves not just treating the patient but also paying attention to the overall satisfaction the patient derives while obtaining the service. This has made satisfaction in healthcare services a top priority for both healthcare professionals and patients. However, the costs of healthcare services continue to be key sources of hardship for many households, hence the introduction of the National Health Insurance Scheme (NHIS) service in Nigeria to lessen the financial burden of accessing healthcare. The study investigated how patient satisfaction is impacted by NHIS service in a teaching hospital in Nigeria. The population consists of all enrollees of NHIS at the University of Benin Teaching Hospital (UBTH). Copies of the questionnaire used for the study were administered to NHIS enrollees seeking medical care in three departments of the hospital, namely: General out-patient, Maternity, and Dental. Out of the 200 questionnaires administered, 182 (General out-patient department – 79, Maternity department – 52, and Dental – 51) were found usable. To access the patients in the aforementioned departments of UBTH, convenience sampling, a form of non-probability sampling method, was applied. The method was chosen because it allows for simple access to and contact with target respondents. Multiple regression analysis was used to establish the statistical significance and relationship between patient satisfaction and NHIS services, such as accessibility, empathy, reliability, tangibility, responsiveness, and waiting time. The study found that accessibility, reliability, and waiting time have a significant impact on patient satisfaction with NHIS services. The study recommends that a more efficient and sustainable model should be designed and implemented in hospitals to minimise waiting time by engaging more health professionals and experts, as well as re-engineering the existing patient flow should be incorporated into the model. The study concludes that empirically investigating the quality of NHIS services and patient satisfaction in healthcare is important in several ways. First, it increases our understanding of service quality and patient satisfaction in particular, as well as service marketing in general, thereby laying the groundwork for future research. Secondly, the management of healthcare organisations will be able to spot any unsatisfactory service elements, which will serve as the basis for designing effective strategies to raise service quality in the healthcare industry.

The Role of Trust in the Pattern of Enrollment to a Social Health Insurance Scheme and Distribution of Healthcare Facilities in Ibadan, Southwest Nigeria.

The National Health Insurance Scheme (NHIS) of Nigeria established in the year 2005 aims to minimize the inequity of access to quality healthcare services in Nigeria. As of the year 2017, enrollment in NHIS-accredited facilities in the southwest region of Nigeria was significantly clustered, with more than three-quarters of NHIS enrollees registered with only 10% of the available NHIS-accredited facilities in the six states of the region. This study explored the factors associated with the skewed distribution of enrollees across facilities and the influence of stakeholders. This is a descriptive, qualitative, case study design among stakeholders of the NHIS in Ibadan, Oyo State, Southwest, Nigeria. In-depth interviews were conducted between March and June, 2019, with all selected individual stakeholders as listed earlier. Data analysis was done using an inductive thematic approach. Across the board, there was a low level of trust in government and government policies among healthcare providers and enrollees. Few healthcare providers were willing to render services under the scheme at inception. The majority of the enrollees were compelled to register with the few available healthcare providers. Among the enrollees, a few personally chose healthcare facilities and providers that were perceived to render better quality services to receive care. Priority should be given to building trust among stakeholders in the NHIS as this would facilitate cooperation and better working relationship, and reposition the scheme for better performance.

Geospatial distribution and bypassing health facilities among National Health Insurance Scheme enrollees: implications for universal health coverage in Nigeria.

BackgroundThis study was carried out to enable an assessment of geospatial distribution and access to healthcare facilities under the National Health Insurance Scheme (NHIS) of Nigeria. The findings will be useful for efficient planning and equitable distribution of healthcare resources.MethodsData, including the distribution of selected health facilities, were collected in Ibadan, Nigeria. The location of all facilities was recorded using Global Positioning System and was subsequently mapped using ArcGIS software to produce spider-web diagrams displaying the spatial distribution of all health facilities.ResultsThe result of clustering analysis of health facilities shows that there is a statistically significant hotspot of health facility at 99% confidence located around the urban areas of Ibadan. The significant hotspot result is dominated by a feature with a high value and is surrounded by other features also with high values. Away from the urban built-up area of Ibadan, health facility clustering is not statistically significant. There was also a high level (94%) of bypassing of NHIS-accredited facilities among the enrollees.ConclusionsLopsided distribution of health facilities in the study area should be corrected as this may result in inequity of access to available health services.

The bypassing of healthcare facilities among National Health Insurance Scheme enrollees in Ibadan, Nigeria.

BackgroundBypassing occurs when patients knowingly visit a health facility other than the one they live nearest to. In Ibadan, southwest Nigeria, the majority of enrollees in the National Health Insurance Scheme (NHIS) receive medical care in just 12% of the available NHIS-accredited facilities. Given that enrollees access healthcare services at highly subsidized rates under the scheme, this study aimed to determine the factors responsible for the observed distribution of enrollees across these health facilities.MethodsThe study was a descriptive cross-sectional survey conducted among NHIS enrollees receiving care at outpatient departments of five randomly selected accredited health facilities in Ibadan. A total of 311 NHIS enrollees were consecutively recruited and a semistructured, pretested, interviewer-administered questionnaire was used to elicit information from respondents. Descriptive and inferential statistics were used to present results at 5% level of significance. Distance traveled by patients from their residence to the facilities was measured using Google maps.ResultsThe mean age of respondents was 37.1±16.1 y. There were 167 (53.7%) males and 224 (72.3%) were married. The bypassing rate was 174 (55.3%). More than a third of enrollees, 127 (41.0%), reported that their hospital choice was made based on physician referral, 130 (41.8%) based on personal choice, 26 (8.4%) based upon the recommendation of the Health Management Organization (HMO), while 27 (8.7%) were influenced by friends/family/colleagues. Bypassing was positively associated with educational status (X2 = 13.147, p=0.004). Respondents who bypassed expended additional time and money traveling to the farther away hospitals, 35.1 (±34.66) min and 389.51 (±545.21) naira per visit, respectively.ConclusionThe level of bypassing among enrollees was fairly high. Enrollees should be properly guided regarding the need to access healthcare in facilities closer to them by their HMOs and physicians in the case of referrals. This will reduce bypassing and the cost of travel leading to better outcomes among enrollees.

Enrollees' Knowledge and Satisfaction with National Health Insurance Scheme Service Delivery in a Tertiary Hospital, South West Nigeria.

Background:Social health insurance scheme provides a platform for mobilizing revenue for health and enhances universal health-care coverage. In addition, knowledge about patients' satisfaction with health care under the scheme will help in identifying gaps and provides evidence toward strengthening the scheme. This study assessed enrollees' knowledge about the National Health Insurance Scheme (NHIS) and satisfaction with health services provided under the scheme.Materials and Methods:The study was a descriptive cross-sectional survey conducted among the NHIS enrollees accessing health-care services in the University College Hospital, Ibadan. A total of 373 individuals were consecutively recruited for the study, and a semi-structured, pretested interviewer-administered questionnaire was used to obtain information from respondents. Descriptive statistics was used to present results, and Chi-square test was used to test for the association between categorical variables. The level of significance was set at P < 005.Results:The mean age was 42.5 ± 10.0 years. Of the respondents, 209 (56.0%) were male and 359 (96.2%) were married. About two-thirds, 227 (60.9%), had good knowledge about the NHIS. Majority of the respondents 303 (81.2%) reported paying for some of the costs of service (drugs, laboratory tests, consultation fees, and X-ray) through out-of-pocket and of these, 218 (71.9%) reported that such payments were occasional. Overall, slightly more than half, 197 (52.8%), of the respondents were satisfied with service delivery under the scheme. Female respondents were significantly more satisfied with health-care services (χ2 = 3.894,P = 0.048).Conclusion:There was good knowledge of NHIS, but the level of satisfaction with service delivery was not outstandingly appreciable. There is an urgent need to improve on all areas of quality of service to improve satisfaction with care among enrollees in the scheme.

Asimetrične informacije i ponašanje rizično po zdravlje u Nacionalnom programu zdravstvenog osiguranja u metropoli Džos, Nigerija

Access to quality healthcare is the primary purpose for which the National Health Insurance Scheme (NHIS) in Nigeria was introduced. It is believed that the introduction of the NHIS for workers will reduce their engagement in health-risk behavior. Despite the existence of the NHIS, its enrollees (i.e. insured workers) are still complaining of the poor healthcare delivery by the service providers. As a result, some of them are still engaging themselves in a detrimental health-risk behavior due to public health workers' moral hazard and a short supply of drugs in public hospitals. This study was undertaken in Jos metropolis so as to ascertain the extent to which moral hazard and the disclosure of partial information about the NHIS lead to a health-risk behavior among civil servants. The research has shown a moderate level of the moral hazard demonstrated by the NHIS service providers since, within the measurement range from 1 to 7, the overall average significantly falls to 4. Contrary to the moderate moral hazard demonstrated by the NHIS service providers, the majority of the NHIS enrollees were found to averagely demonstrate a low health-risk behavior.

An Appraisal of Clients’ Utilization of National Health Insurance Scheme (NHIS) Services at the Kubwa General Hospital

NHIS was launched officially on 6th of June 2005. The Scheme is designed to provide comprehensive health care at affordable costs, covering employees of the formal sector, self-employed, as well as rural communities, the poor and the vulnerable groups. However, client satisfaction of services rendered continues to be a major concern for the improvement of NHIS. This study is designed to determine the level and causes of dissatisfaction of clients accessing NHIS clinic at the Kubwa General Hospital, Kubwa, FCT, Abuja. This study employed a descriptive cross sectional survey. 279 NHIS enrollees were recruited for this study at the Kubwa General Hospital. Questionnaires were administered and the level of dissatisfaction and satisfaction of NHIS services were analyzed. The satisfaction rate was 69.2% while the dissatisfaction rate was 22.9%. The respondents were satisfied with the attitude of health workers in NHIS clinic, Kubwa. However, they were dissatisfied with waiting time, attitude of record officers and those in pharmacy department. This study found that the level of dissatisfaction with NHIS services is high despite a high satisfaction level. The Attitude of health workers may influence the dissatisfaction of enrollees. NHIS is still limited to the formal sector.

Perception of Factors Influencing Primary Health-Care Facility Choice Among National Health Insurance Enrollees of a Northwest Nigerian Hospital.

Background:The National Health Insurance Scheme (NHIS) of Nigeria was designed to eliminate known cultural, physical, and resource-related barriers to quality health-care access. Although choice of primary health-care facility (PHF) remains in the domain of the scheme enrollees, little is known about factors influencing their choice. Hence, the study of the perception of factors influencing PHF choice among NHIS enrollees of a northwest Nigerian hospital becomes imperative.Methods:This was a cross-sectional study of 284 principal enrollees randomly selected from patients attending the NHIS clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, using a designed, pretested, investigator-administered questionnaire. Their sociodemographics and factors influencing their choice of the clinic were assessed.Results:Respondents’ mean age was 40.9 ± 9.0 years and they were predominantly males (83.1%) with tertiary education. Median distance between their homes and PHF was 7.6 ± 12.5 km. Most respondents were aware of other accredited PHFs in the city and believed it was their right to choose a PHF. Among the various factors influencing their choice of index PHF were better functioning equipment (83.5% of respondents), more specialists/trained health workers (78.5%), ease in receiving specialist care (69.4%), and better overall quality of care (78.9%).Conclusion:There are multiple factors associated with enrollee choice of PHF in this study. The NHIS enrollees value the presence of functioning equipment/facilities, ease in receiving specialist care, and overall high quality of care in their choice of PHF. Improving enrollee enrollment at accredited PHF may require addressing these factors.

The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana.

This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and "timing" of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life. Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness episode. Older persons with active NHIS membership frequently used health facilities (β = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more likely to attend health facility earlier (β = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eβ = 2.149, SE = 0.240, p ˂ .005), social support recipients (eβ = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eβ = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services. Ghana's NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.

Service Quality: An Empirical Study of Expectations versus Perception of National Health Insurance Scheme Enrollees in Federal Universities in South East, Nigeria

Service Quality: An Empirical Study of Expectations versus Perception of National Health Insurance Scheme Enrollees in Federal Universities in South East, Nigeria

Impact of structural and interpersonal components of health care on user satisfaction with services of an outpatient clinic of a Nigerian tertiary hospital

Background: Patient satisfaction plays a key role in health-care reforms and service delivery. It is determined by patient's perception of the structural, interpersonal, and technical components of care. With current efforts toward universal coverage, government-owned National Health Insurance Scheme (NHIS)-accredited health facilities may need to improve the structural and interpersonal aspects of patients' care to survive in the emerging competitive health-care industry in Nigeria. Materials and Methods: A cross-sectional study of 220 NHIS enrollees randomly selected from patients attending the Staff Clinic of Aminu Kano Teaching Hospital Kano assessed patients' satisfaction with the structural (service-window-locations, cleanliness, adequacy of seats and toilets, and staff sufficiency) and interpersonal (staff friendliness, communication, respectfulness, response-to-requests, and efficiency) components of care as well as overall clinic satisfaction using a modified general practice assessment questionnaire. Results: Most of the respondents (65.9%) were satisfied with the clinic services. Respondents' satisfaction with the clinic's cleanliness, ease in locating medical records' unit and retrieving laboratory results, adequacy of doctors, friendly/respectful and responsive cashiers and clinical assistants (CAs), receiving satisfactory explanation on how to use prescribed drugs and unavailable drugs were all associated with the overall clinic satisfaction. However, cashiers' efficiency (odds ratio [OR] = 6.5, P = 0.006) and CAs' responsiveness (OR = 5.0, P = 0.03) were the predictors of overall satisfaction. Conclusion: Improvements in patients' overall satisfaction with the clinic services may require increasing the proportion of patients satisfied with the cashiers' efficiency and CAs' responsiveness (or those with similar roles) in service delivery.