Health Insurance and Healthcare Quality: A Comparative Study between Insured and Uninsured Patients at a Teaching Hospital in Northeast Nigeria

Abstract

Objective: Patients’ perception of the quality of care is essential in assessing health services and feedbacks from patient satisfaction surveys are useful in healthcare quality improvements.
 Methods: A descriptive cross-sectional study was done to evaluate satisfaction with the quality of care among insured patients under the National Health Insurance Scheme (NHIS) and uninsured (Out-of-Pocket paying) patients at University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno State, Nigeria. Data were collected from 115 respondents from each group selected by systematic random sampling; using self-administered questionnaires. Analysis was done using IBM SPSS Statistics 20.0.
 Results: The overall mean satisfaction for the uninsured group (73.1 ± 7.2) was higher than that of the insured group (71.2 ± 7.5). However, the difference was not statistically significant, p = 0.063. The observed satisfaction levels in the various areas of services accessed among the insured and uninsured group in this study are comparable, except for the significant differences observed in satisfaction with hospital facilities and the availability of prescribed drugs, suggesting the need for the improvement of hospital facilities and availability of drugs.
 Conclusion: Despite complaints about the NHIS, it is still generally preferred to out-of-pocket payment by both groups. Therefore, more efforts should be made to expand the population coverage of health insurance to allow the inclusion of more people, while the need for continuous improvement of quality health services cannot also be overemphasized.

Patient satisfaction and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia: a facility-based comparative cross-sectional study

“…The findings of this study show that overall patient satisfaction with healthcare services was 65.6%. The findings of this study are in harmony with studies done in Arsi, Ethiopia (63.4%) (31), northcentral Nigeria (63.1%) (32), and southeastern Nigeria (68.8%) (25). However, the findings of this study were higher than those of studies conducted in Nigeria (58.1%) (25), Ethiopia (54.7%) and (54.1%) (33,34), Turkey (53.3%) (35), Ghana (43%) (36), and southern Nigeria (40%) (37).…”

“…Our findings also revealed that the satisfaction level among insured patients was 68.8%, while it was 62.4% among uninsured patients. This finding is lower than studies conducted in Northern Nigeria ( 25 ), Nepal (83.2% insured and uninsured patients, 84.8%) ( 38 ), Tanzania (71% insured and 81% uninsured patients) ( 28 ), North East Nigeria (76.5% insured patients and 68.7% uninsured patients) ( 25 ), and Ethiopia (79.4% insured and 75.7% uninsured patients) ( 39 ). The variation in sample size, socioeconomic level, and study design could all be contributing factors to the reason.…”

“…Patient expectations were measured by the patient’s expectations, wants, and thoughts about what needed to be completed ( 25 ).…”

“…n = sample size. P1 = proportion of satisfaction on availability of drugs in insured patients was taken as 60%, and P2 = proportion of satisfaction on availability of drugs in non-insured patients was taken as 72% from the study conducted in public hospitals in Addis Ababa, Ethiopia (25). α = the level of significance (0.05).…”

Does Insurance Status Influence Outpatient Flow? Cross-Sectional Comparison of Insured and Uninsured Patients in a Tertiary Hospital in Nigeria

“…Plausible reasons adduced for this were better workflow, fewer workloads, and stricter third-party supervision in the NHIS clinic. The obverse report of uninsured patients being more satisfied with the quality of care ( 28 ) and time spent was adduced to the cash-backed nature of the dealings with providers who are incentivized by tokens from patients who are in turn, readily given prompt and better attention by health workers ( 29 , 30 ).…”