BACKGROUND AND PURPOSE OF RESEARCH:
Nigeria’s National Health Insurance Scheme (NHIS) was setup to secure
universal access to affordable quality care. However, after 11yrs, and despite launching
different programs, NHIS coverage is still less than 3% nationally, and out-of-pocket
payments (OOP) remain the major health financing mechanism. The reasons for the low
level of enrollment in NHIS are not well understood. Quality of care may be a factor in
enrolment. This study compares technical and perceived quality of care between NHIS
enrollees and the uninsured, using diabetes as a tracer condition. It also compares OOP
and generic prescription patterns by health insurance enrollment status.
METHODS:
We conducted a cross sectional clinic-based intercept study. Subjects were adult
diabetes patients recruited from 10 NHIS accredited hospitals in Abuja, Nigeria. Data
collection included survey and chart review, covering technical aspects of quality –
performance of eye and feet exam and HbA1c request; perception of quality, generic
medication prescribing pattern and OOP. We performed logistic regression analysis to
evaluate the effect of NHIS enrollment status on the technical quality of care, perceived
quality of care, generic prescribing and OOP.
RESULTS:
Out of 455 participants, 149 (33%) were NHIS enrollees, 10 (2%) were enrolled
in private health insurance and 296 (65%) had no insurance. After adjusting for correlated
data and controlling for facility, BMI, chronic disease score, age, sex, and education,
patients under NHIS coverage were 0.85 times less likely to have eye exam (Cl=0.4–1.8),
0.98 times less likely to have feet exam (Cl= 0.4–2.2), and 0.98 times less likely to have
A1c test requested (Cl= 0.7–1.3), compared to those without insurance. These findings
were not statistically significant at alpha=0.05. On the other hand, compared to the
uninsured, NHIS covered patients perceived care to be worse even though they spent
significantly less, 56% (Cl=45%–69%) in OOP in public hospitals.
DISCUSSION/CONCLUSION:
Perception of care quality under the NHIS could be a contributory factor to the
reluctance of prospective enrollees. To advance towards the goal of universal health
coverage, NHIS must strengthen policy to overcome identified barriers such as
medication stock outs and wait times at the facility level.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/23376 |
| Date | 09 June 2017 |
| Creators | Okoro, Chijioke |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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