A Preliminary Study on Enrollees Perception and Experiences of National Health Insurance Scheme in Lagos State, Nigeria
B. Adewale *
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
A. K. Adeneye
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
S. M. C. Ezeugwu
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
E. E. Afocha
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
A. Z. Musa
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
C. A. Enwuru
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
J. I. Yisau
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
T. Y. Raheem
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
M. A. Sulyman
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
A. A. Adeiga
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
O. M. Olayemi
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
I. A. O. Ujah
Health Policy and Systems Research Group, Nigerian Institute of Medical Research, Lagos, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aim: To assess enrolees’ perception and experiences on the National Health Insurance Scheme, launched in Nigeria, in 2005 and made mandatory for all Federal civil servants.
Study Design: This descriptive cross-sectional study conducted between August and September 2013 focused on civil servant enrolees of three tertiary health institutions in Lagos, South-West Nigeria.
Methodology: Three tertiary health institutions were purposively selected. Systematic sampling was employed in selecting 150 enrolees. Quantitative data were collected from each consenting selected enrolee using semi-structured questionnaire which probed into demographic characteristics, knowledge, expectations, services accessed, experiences, perceptions and, suggestions for improvement.
Results: A total of 143 enrolees (males 43.7%; females 56.3%) completed the questionnaire. Majority (97.2%) had knowledge of the scheme: easy access to affordable healthcare (40.7%), subsidized health care services (22.2%) and pooling of resources (11.1%). Subsidized treatment, quality healthcare provision and free treatment were the most mentioned expectations. Treatment and general care were the most accessed services (55.7%). One in every five enrolees (22.9%) never accessed the services and, 18% had no knowledge of complaints channels. More than half (59.8%) were dissatisfied with services accessed for reasons ranging from drug unavailability (27.8%) to poor quality of service (12.6%) and out-of-pocket payment on drugs and tests (11.4%). Majority (57%) however claimed reduction in out-of-pocket expenses. Major suggestions proffered by enrolees (53.1%) for improving the scheme covered regular monitoring, continuous availability of genuine drugs, sensitisation, prompt response to enrolees’ complaints and continuous review of the policy.
Conclusions: Regular monitoring of the scheme’s operations is expected to contribute greatly to improvement of the scheme which should minimise out-of-pocket health expenses. Continuous enlightenment is desirable with emphasis on ensuring enrolees’ satisfaction for sustainability to secure the universal health coverage target in the country.
Keywords: Health insurance, perception, civil servants, Nigeria.