Enrollees’ Satisfaction with Health Service Provision Under National Health Insurance Scheme at University of Nigeria Teaching Hospital Ituku-Ozalla.
ABSTRACT
The cost of accessing quality healthcare is still a serious challenge to most Nigerians. As a means of alleviating this challenge, the Federal Government of Nigeria introduced the National Health Insurance Scheme.
The purpose of this study was to assess enrollees satisfaction with health service provision under the Formal Sector Social Health Insurance Scheme in University of Nigeria Teaching Hospital (UNTH).
The research method was a descriptive Cross-Sectional Survey design. Four hundred and seventy (470) respondents were selected using systematic random sampling.
Data were collected using semi structured Satisfaction Survey Questionnaire adapted from the Patient Satisfaction Questionnaire short form (PSQ 18) by Marshall and Hays (1994) and World Health Organization (WHO) Health System Responsive Survey Version 70 (WHO 2002).
Findings revealed that respondents were satisfied with the registration process into the scheme, process of getting ID card, respect from the providers, interest of the providers towards their care as well as their clarification on regimen (X ≥3.0); while they were not satisfied with the availability of healthcare providers, especially the specialists whenever needed (X ≤ 3.0).
They were also not satisfied with their involvement in decision making, attention they get from the health care providers, length of time they spent waiting to access healthcare, laboratory investigations and collection of prescribed drugs (X < 3.0). The respondents also were not satisfied with availability of drugs and diagnostic facilities like x- ray, ultrasound in the NHIS list.
Finally majority of the respondents rated the overall satisfaction poor and would not recommend the facility for family members/friends. Based on the findings it was concluded that the enrollees’ overall satisfaction with service provision was poor.
Recommendations were made which included that periodic survey of enrollees’ satisfaction and factors influencing it should be carried out by health Institutions and findings used as guide in policy and decision making.
TABLE OF CONTENTS
Title Page i
Approval Page ii
Certification iii
Dedication iv
Acknowledgement v
Table of Contents vi
List of Tables ix
List of Figures x
Abstract xi
CHAPTER ONE: INTRODUCTION
Background to the Study 1
Statement of the Problem 3
Purpose of the Study 5
Objectives of the Study 5
Research Questions 5
Significance 6
Scope of the Study 6
Operational Definition of Terms 6
CHAPTER TWO: LITERATURE REVIEW
Conceptual review 8
Social health insurance scheme in Nigeria 12
How the scheme operates in Nigeria 14
Objectives of the programme 16
Benefits of the scheme 16
Concept of satisfaction 17
Concept of user satisfaction 17
Theoretical review 20
Empirical review 24
Summary of literature review 29
CHAPTER THREE: RESEARCH METHOD
Research Design 31
Area of Study 31
Population of Study 32
Sample 32
Sampling Technique 32
Instrument for Data Collection 33
Validity of Instrument 33
Reliability of Instrument 34
Ethical Considerations 34
Procedure for Data Collection 34
Method of Data Analysis 35
CHAPTER FOUR
Presentation of Results 36
CHAPTER FIVE: DISCUSSION
Discussion of major findings 44
Enrolees satisfaction with the process of accessing health care under formal sector
Social Health Insurance Scheme in UNTH Enugu 44
Enrolees satisfaction with waiting times before receiving health services under formal sector
Social Health Insurance Scheme in UNTH Enugu 46
Enrolees satisfaction with availability of drugs 48
Enrolees willingness to access healthcare services under formal sector Social Health Insurance
Scheme in UNTH whenever they needed medical attention 49
Conclusion 50
Implication of findings 50
Limitation to Study 51
Suggestion for Further Studies 51
Summary 51
Recommendation 53
References 54
Appendices:
INTRODUCTION
Health care financing continues to stir debates around the world. Many low and middle income countries (LMICs) keep on exploring different ways of financing their health systems because their health systems are chronically under-funded (Dalinjon &Laar 2012).
There are rising interest of many on escalating health care costs globally and how it should be financed. The form and level of health care financing are now a major policy for most developing country governments.
Several approaches abound in financing healthcare, ranging from fees- for- service to private insurance, general taxation, social insurance, community financing, loans and grants (Onyedibe, Goyit & Nnadi, 2012).
User fees were initially introduced at the point of service delivery in some countries in order to generate revenue for the running of their health systems (Dalinjong & Laar 2012).
While in some countries, the introduction of user fees led to improvement in the quality of health care services, the overwhelming evidence suggests that user fees constitute a strong barrier to the utilization of health care services, as well as preventing adherence to long term treatment among poor and vulnerable groups (Onyedibe et al, 2012).
Many developing countries inherited heavy dependence on tax revenues from the colonial rule to finance health care. In some countries where social security schemes have been the method of caring for the health of the people, the government care for the populace from her own sources of revenue.
The services are provided at minimal or no direct cost to all the citizens in cases of most comprehensive schemes. Raising finance can be from PAYE tax (Pay as you earn) which is progressive and regressive if from indirect tax (Dalinjong & Laar, 2012)
Loans and grants may also be used to provide resources for health care financing. This can be through technical assistance or provision of free drugs. Loans are mostly used for capital financing while grants have the subsidizing effect on the cost of provision of service.
Many countries of the world have undergone reforms since late 1970s though the World Bank advocated the use of direct user-charge finance system in 1987 (Obansa & Akinnagbe, 2013).
REFERENCES
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