Patient Satisfaction with Quality of Care in NHIS Clinic in a Federal Tertiary Hospital in Southwest Nigeria
Main Article Content
Keywords
patient satisfaction, National Health Insurance, NHIS, healthcare services, quality of care, Nigeria
Abstract
Background: The National Health Insurance Scheme (NHIS) now named National Health Insurance Authority (NHIA) was launched to achieve easy access to affordable quality healthcare for all Nigerians. This study aimed at evaluating patients' satisfaction with the services accessed at the NHIS clinic in a tertiary teaching hospital in Southwest, Nigeria.
Methodology: This cross-sectional study carried out at the Federal Teaching Hospital, Ido-Ekiti, Nigeria included all adult patients (> 18 years) who have been enrolled in the scheme for at least one year and have accessed healthcare at the clinic within three months preceding the study. Data was collected from 391 patients using a semi-structured interviewer-administered questionnaire in an exit interview. Data on patients’ satisfaction with the quality of care was adapted from the Patient Satisfaction Questionnaire (PSQ 18). Data entry and analyses were done with the SPSS version 26.0.
Results: The mean age (±SD) of the respondents was 43.5±14.5 years. More than half 204 (52.2%) of the patients were male, 291 (74.4%) were married, and 319 (81.6%) had attained tertiary level education. The overall satisfaction score was 75.02 ± 6.37, with communication (78.5 ± 11.6) and interpersonal manner (79.6 ± 10.0) having the highest scores. Predictors of overall satisfaction were longer travel time (p < 0.001) and readiness to return to the clinic for treatment (p = 0.001).
Conclusion: There was a high level of patient satisfaction with the quality of healthcare services rendered at the NHIS clinic, with domains related to interpersonal and communication ranked highest. Travel time and willingness to return were factors significantly associated with patients’ satisfaction. There is a need for the management of NHIS clinics to continuously improve on the quality of healthcare services provided.
References
2. NHIS: National Health Insurance Scheme Operational Guidelines. National Health Insurance Scheme Abuja, Nigeria. October 2012. [Accessed February 11, 2022]. Available at https://www.nhis.gov.ng/?media_dl=2714
3. Michael GC, Aliyu I, Grema BA. Trends and correlates of patient satisfaction with services under the National Health Insurance Scheme of Nigeria: A review. J Med Trop 2019; 21:1-5.
4. Akande T, Salaudeen A, Babatunde O. The effect of the National Health Insurance Scheme on the utilization of health services at the Unilorin Teaching Hospital staff clinic, Ilorin Nigeria. Health Sci J 2011; 5:98–106.
5. Mohammed S, Sambo MN, Dong H. Understanding client satisfaction with a health insurance scheme in Nigeria: factors and enrollees experiences. Health Res Policy Syst 2011; 9:20.
6. Osungbade KO, Obembe TA, Oludoyi A. Users' satisfaction with the services provided under national health insurance scheme in South-Western Nigeria. Int J of Trop Dis & Health. 2014; 4:595-607.
7. Daramola OE, Maduka WE, Adeniran A, Akande TM. Evaluation of patients’ satisfaction with services accessed under the national health insurance scheme at a Tertiary Health Facility in North Central, Nigeria. Journal of Community Medicine and Primary Healthcare. 2017; 29(1):11- 17.
8. Daramola OE, Adesina CT, Adeniran A, Akande TM. Healthcare quality under the national health insurance scheme: A study among patients at a tertiary health institution in Nigeria. International Journal of Science & Healthcare Research. 2019; 4(1):303-309.
9. Iliyasu Z, Abubakar IS, Abubakar S, Lawan UM, Garija AU. Patients' satisfaction with services obtained from Aminu Kano Teaching Hospital, Kano, Northern Nigeria. Nigerian journal of clinical practice. 2010; 13(4):371-378.
10. Reeder LG. The patient-client as a consumer: Some observations on the changing professional-client relationship. J. Health Soc.
Behav 1972; 13(4): 406-412.
11. Daramola OE, Oderinde AF, Anene CM, Abu JM, Akande TM. Health Insurance and Healthcare Quality: A Comparative Study between Insured and Uninsured Patients at a Teaching Hospital in Northeast Nigeria. International Journal of Tropical Disease & Health. 2020; 13-9.
12. Cleary PD. The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement. BMJ 1999; 319:720-1.
13. Sanusi A, Awe AT. An assessment of awareness level of national health insurance among healthcare consumers in Oyo state, Nigeria. Medwell J 2009; 4:143-8.
14. Ware JE, Snyder MR, Wright R. Defining and measuring patient satisfaction with medical care. Eval. Prog. Planning, 1983; 6: 247-263.
15. Abdulrahman SA, Olaosebikan MO. An assessment of the level of implementation and impact of the National Health Insurance Scheme (NHIS) on the health care system in Yobe State, North-Eastern Nigeria. J Dental Med Sci 2017; 16:60-7.
16. Nwankwor O, Okoronkwo I, Enebeli U, Ogbonna U, Iro O. Assessment of Clients’ Perceived Satisfaction and Responsiveness of Outpatient Health Care Services Within the National Health Insurance Scheme at University of Nigeria Teaching Hospital, Enugu State, Nigeria. European Scientific Journal. 2020;16(15)
17. Michael GC, Grema BA, Yakubu SO, Aliyu I. Utilisation of staff clinic facility in a Northwest Nigeria hospital: emerging challenges for the National Health Insurance Scheme. S Afr Fam Pract 2016; 58:1:37-41.
18. Ibanga AA, Nkanga DG, Asana UE, Duke RE, Etim BA, Nkanga ED, et al. Patients’ satisfaction with eye care services in University of Calabar Teaching Hospital. IAIM, 2017; 4(9):110-118.
19. Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex Publishers; 2004. p. 117-20.
20. Marshall GN, Hays RD, The Patient Satisfaction Questionnaire Short Form (PSQ-18). 1994 Jan 1;
21. Abdulsalam A, Khan HTA. Hospital Services for Ill Patients in the Middle-Belt Geopolitical Zone, Nigeria. Illness, Crisis & Loss. 2017;28(1):105413731668958.
22. Iloh G, Ofoedu J, Njoku P, Odu F, Ifedigbo C, Iwuamanam K. Evaluation of patients’ satisfaction with quality of care provided at the National Health Insurance Scheme clinic of a tertiary hospital in South-Eastern Nigeria. Nigerian Journal of Clinical Practice.2012;15(4):469-474.
23. Dalinjong PA, Laar AS. The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana. Health Economics Review. 2012;2(1):13.
24. Bara AC, van den Heuvel WJA, Maarse JAM, van Dijk JP. Users’ satisfaction with the Romanian health care system: an evaluation of recent health care reforms. European Journal of Public Health. 2012;12(4):39-40.
25. Chun CB, Kim SY, Lee JY, Lee SY. Republic of Korea: Health system review. Health Systems in Transition: World Health Organization on behalf of European Observatory on Health Systems and Policies. 2009;11:1-188.
26. Ughasoro MD, Okanya OC, Uzochukwu B, Onwujekwe OE. An exploratory study of patients’ perceptions of responsiveness of tertiary health care services in Southeast Nigeria: A hospital-based cross-sectional study. Nigerian Journal of Clinical Practice. 2017;20(3):267-273.
27. Daneshkohan A, Zarei E, Ahmadi-Kashkoli S. Health system responsiveness: a comparison between public and private hospitals in Iran. International Journal of Healthcare Management. 2018;13(sup1):296-301.
28. Hamid SA, Begum A. Responsiveness of the urban primary health care delivery system in Bangladesh: A comparative analysis. The International Journal of Health Planning and Management 2018;34(1):251-62.
29. Adesanya T, Gbolahan O, Ghannam O, Miraldo M, Patel B, Verma RV, et al. Exploring the responsiveness of public and private hospitals in Lagos, Nigeria. Journal of Public Health Research. 2012;1(1):2-6.
30. Chao J, Lu B, Zhang H, Zhu L, Jin H, Liu P. Healthcare system responsiveness in Jiangsu Province, China. BMC Health Services Research. 2017;17(1):31.
31. Mohammed S, Bermejo JL, Souares A, Sauerborn R, Dong H. Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users’ perspectives. BMC Health Services Research. 2013;13(1):502.
32. Nguyen T, Trinh T, Xuan, Tran, Nguyen, Huong et al. Association between patient satisfaction and the willingness to return for rehabilitation- A Pilot Study. The Open Public Health Journal. 2021;14:455-461.
33. Okonta K, Ogaji D. Relationship Between Patient Satisfaction and Willingness to Comply With Physicians’ Recommendations in Referral Surgical Outpatient Clinic in Nigeria. Journal of Patient Experience. 2020;7(6):1556-1562.
34. Cabrera-Barona P, Blaschke T, Kienberger S. Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach. Soc Indic Res. 2017;133(2):719–39.
35. Eriksson I, Lindblad M, Möller U, Gillsjö C. Holistic health care: Patients’ experiences of health care provided by an Advanced Practice Nurse. Int J Nurs Pract. 2018; 24(1):e12603. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ijn.12603
36. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013; 12(1):18.
37. Haruna-Ogun OA. Geographical differentials in uptake of antenatal care services in Nigeria. Health Care Women Int. 2018;39(1):34–49.
38. Nwanaji-Enwerem O, Bain P, Marks Z, Nwanaji-Enwerem P, Staton CA, Olufadeji A, et al. Patient satisfaction with the Nigerian National Health Insurance Scheme two decades since establishment: A systematic review and recommendations for improvement. African J Prim Heal Care Fam Med. 2022;14(1).
39. Fang J, Liu L, Fang P. What is the most important factor affecting patient satisfaction – A study based on gamma coefficient. Patient Prefer Adherence. 2019;13:515–25.
40. Aydin S. Factors Affecting Patient Satisfaction with Healthcare System of Turkey. (Doctoral dissertation). 2018. Available from https://scholarcommons.sc.edu/etd/4946
41. Naidu A. Factors affecting patient satisfaction and healthcare quality. Int J Health Care Qual Assur. 2009 Jun 12;22(4):366–81.
42. Baltaci D, Eroz R, Ankarali H, Erdem O, Celer A, Korkut Y. Association between patients’ sociodemographic characteristics and their satisfaction with primary health care services in Turkey. Kuwait Med J. 2013;45(4):291–9.
43. Abraham A, Olumodeji D, Oluwole E. Influence of socio demographic variables on patient’s satisfaction with quality of nursing care in teaching hospitals in northern Nigeria. Int J Med Heal Res. 2015;1:18–24.
44. Jarosz K, Młynarska A. The Impact of Sociodemographic Factors on the Rationing of Nursing Care in Urology Wards. Nurs Reports. 2023;13(1):561–72.
45. Djordjevic IM, Vasiljevic D. The effect of sociodemographic factors on the patient satisfaction with health care system. Serbian J Exp Clin Res. 2019;20(3):251–5.
46. Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, et al. Engaging patients to improve quality of care: A systematic review. Implementation Science. 2018; 13:1–22.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.
Taiwo Amos Omolayo , Health Insurance Department, Federal Teaching Hospital, Ido-Ekiti, Nigeria
Honourary Consultant