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’s 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 the need for the management of NHIS clinics to continuously improve on the quality of healthcare services provided.
Keywords: Patient’s Satisfaction, National Health Insurance Scheme, NHIS, Healthcare Services, Quality of Care, Nigeria
Introduction
The National Health Insurance Scheme (NHIS) now named National Health Insurance Authority (NHIA) was launched in 2005 amidst dwindling funding and the poor state of the nation's healthcare to achieve easy access to affordable quality healthcare for all Nigerians by protecting families from the financial hardship of huge medical bills and providing equitable distribution of health care costs among different income groups [1]. The key roles and responsibilities of healthcare facilities under the NHIS are providing services in full compliance with the NHIS operational guidelines and essentially ensuring patient satisfaction [2]. Steady patronage, wider coverage and patients’ satisfaction with NHIS services are decisive in fulfilling the scheme’s objectives of providing improved service delivery [2,3].
Studies have revealed considerable increment in enrolment into and utilization of health services among patients since NHIS started operations [4,5]. Despite that, patients have repeatedly expressed dissatisfaction about the quality of care obtained with recurrent complaints including long waiting times, poor health workers’ attitude and unavailability of prescribed drugs [6-8]. Patients as end users are the focal point of health care service delivery, and these days, patients desire stress-free instant services in this rapidly growing world [9]. Predictably, complaints of dissatisfaction are one of the main reasons patients contacted the Agency and Health Management Organizations (HMOs) channels as well as demand for change in their healthcare providers [7].
Interestingly, reports suggested that satisfied patients were more likely to comply with treatment, keep follow-up appointments and utilize healthcare services [9,10]. Therefore, the success of NHIS operations depends largely on the quality of care provided to patients not to mention studying healthcare quality from the patient’s perspective which supplies valid and reliable information about the quality of care [11]. Similarly, patient satisfaction surveys are valuable tools used in evaluating the quality of both clinical and non-clinical NHIS services [12,13]. While patient satisfaction is simply defined as a patient's judgment on the quality and outcome of care [7], it is the extent to which patients feel that their overall needs and expectations are being met by the service provided [14]. Patient satisfaction is viewed through the prism of ease with which patients access care, perception of waiting time, patient-provider relationship, payment for services, hospital facilities and the environment [9].
Available literature from previous studies conducted in Nigeria that assessed healthcare patients’ satisfaction with the quality of services of NHIS-accredited healthcare facilities showed mixed findings. There are reports of high overall satisfaction ratings with varying levels of satisfaction in different domains of services at various parts of the country ranging from 42 - 83.6% [5-7, 9, 15, 16]. Previous studies have also shown that one of the main reasons for the dissatisfaction of most NHIS patients was the non-availability of prescribed drugs [7,8], delay in enrolment of potential patients [17], and delay in reimbursement of healthcare providers by the HMOs [3]. Identifying correlates of patient satisfaction is integral for targeted strategic planning and addressing the aforementioned challenges threatening the scheme will improve remarkably the quality of services provided [3].
Despite the launch of service compact with all Nigerians (SERVICOM) to enhance service delivery in the public sector, regular patient satisfaction surveys are not done routinely in hospitals [9]. Similarly, the NHIS Formal Sector Social Health Insurance Programme has been operational for over a decade in the selected tertiary teaching hospital still there has been limited literature on patients’ satisfaction with the quality of care of NHIS services bearing in mind that monitoring of patients’ experiences and satisfaction provide the health institution parameters to measure quality of services and determine areas where improvement and or additional services are needed [18].
Furthermore, the mixed findings on patients’ satisfaction in previous studies justify the need for more evidence-based research to ascertain the correlates of patient satisfaction with NHIS services in tertiary health institutions. Therefore, this study is aimed at evaluating patients' satisfaction with the services accessed at the NHIS clinic in a tertiary teaching hospital in Southwest, Nigeria. It is expected that the findings from this study will assist program managers and policymakers in making patient-centred choices in planning strategies to improve the quality of NHIS services in the accredited facilities under the scheme as the country makes continued efforts to achieve universal health coverage [3].
Materials and Methods
This cross-sectional study was carried out at the NHIS clinic of the Federal Teaching Hospital, Ido-Ekiti, Southwest, Nigeria. The hospital is the only federal government tertiary health institution in Ekiti State, and it serves as a referral centre for all other health institutions within the state. It is a 300-bed health facility with a staff strength of over three thousand personnel. The NHIS clinic is the central point where all patients under the health insurance scheme accessing care in the hospital are treated, from where they may be further referred to specialist clinics. The NHIS clinic is headed by a consultant physician along with him and resident doctors from family and community medicine as well as doctors having their one-year compulsory youth service consult patients in this clinic. There are also nurses, pharmacists, laboratory scientists, health information managers and administrative officers in the clinic serving important areas of patients’ health care such as drug dispensaries, side laboratory services and the NHIS administrative desk activities. With about sixty patients being attended daily, the clinic operates 24 hours and 7 days a week.
This study included all adult patients (> 18 years) who are accessing health care at the NHIS clinic, who have been enrolled in the scheme for at least one year and have accessed care within three months preceding the study. Acutely ill-looking patients requiring urgent medical attention were excluded from the study. A minimum number of 391 patients who were recruited for this study was derived through the Leslie–Kish formula (n = Zα2pq/d2) [19] using 63.1% as the proportion of enrollees in a federal tertiary health facility, who were satisfied with NHIS in a previous study [7], 5% margin of error, 95% confidence interval and 10% non-response rate. Every alternating consenting patient seen at the clinic was recruited into the study until the sample size was complete. Patients were interviewed in an exit interview after their clinic consultation.
A semi-structured interviewer-administered questionnaire was used for data collection. This questionnaire had 3 sections: Section A elicited socio-demographic characteristics, section B elicited contextual and clinical characteristics of participants while section C contains questions on patients’ satisfaction with the quality of care, adapted from the Patient Satisfaction Questionnaire (PSQ 18) by Marshalls and Hays [20]. The psychometric properties of PSQ 18 were evaluated with face and content validity assessed by experts (Clinical epidemiologists, Consultant Community Health Physicians, and Consultant Family Physicians) through the review of the instrument. The PSQ 18 is an 18-itemed instrument using a five-point Likert scale. All items were scored so that high scores reflect satisfaction with the quality of care. After item scoring, items within the same subscale were grouped and averaged together to create 7 subscale/domain which include: General satisfaction (Items 3 and 17), technical quality (Items 2, 4, 6, and 14), interpersonal manner (Items 10 and 11), communication (Items 1 and 13), financial aspects (Items 5 and 7), time spent with doctor (Items 12 and 15), accessibility and convenience (Items 8, 9, 16, and 18). The overall satisfaction was derived from an average of all the 18 questions. The individual satisfaction domain as well as the overall satisfaction raw scores were later converted and presented in percentages as patients' satisfaction scores.
Data entry and analyses were done with the SPSS for Windows version 26.0. Data were presented in tables using frequencies and percentages for categorical variables. Mean ± standard deviation (SD) was used to summarize continuous variables. The Shapiro-Wilk test was used to confirm the normality of the patients’ satisfaction scores before using the independent student t-test and one-way analysis of variance (one-way ANOVA) to compare overall patients’ satisfaction scores across the categories of independent variables (sociodemographic, contextual, and clinical factors). A P-value <0.05 was considered statistically significant. Ethical approval for this study was obtained from the Health Research and Ethics Committee of the Federal Teaching Hospital, Ido-Ekiti. Written informed consent was obtained from all selected participants, while confidentiality and privacy were maintained at all stages of the study.
Results
Table 1 shows that 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 education up to the tertiary level. Also, 310 (79.3%) of the patients were Yoruba, with the main occupation 235 (60.1%) being civil servants. The table also revealed that most of the respondents, 312 (79.8%), had ≤ 5 household size, with the mean (±SD) household size of 4.7 (±1.4).
Table 1:
Socio-demographic variables of respondents
| Variable | Frequency (N= 391) | Percentage (%) |
|---|---|---|
| Age (in years) | ||
| ≤ 44 years | 248 | 63.4 |
| ≥ 45-64 years | 101 | 25.8 |
| ≥ 65 years | 42 | 10.7 |
| Mean ± Standard Deviation | 43.5 ± 14.5 | |
| Sex | ||
| Male | 204 | 52.2 |
| Female | 187 | 47.8 |
| Highest level of education | ||
| Up to Secondary | 55 | 14.1 |
| Tertiary | 319 | 81.6 |
| Others | 17 | 4.3 |
| Marital status | ||
| Never married | 78 | 19.9 |
| Married | 291 | 74.4 |
| Divorced/Widowed/Separated | 22 | 5.6 |
| Religion | ||
| Christianity | 332 | 84.9 |
| Islam | 59 | 15.1 |
| Tribe | ||
| Yoruba | 310 | 79.3 |
| Igbo | 59 | 15.1 |
| Others | 22 | 5.6 |
| Main Occupation | ||
| Trader | 40 | 10.2 |
| Farmer | 19 | 4.9 |
| Artisan/Technician | 12 | 3.1 |
| Civil Servant | 235 | 60.1 |
| Professional | 17 | 4.3 |
| Student | 31 | 7.9 |
| Others | 37 | 9.5 |
| Household size | ||
| ≤ 5 | 312 | 79.8 |
| ˃ 5 | 79 | 20.2 |
| Mean ± Standard Deviation | 4.7 ± 1.4 |
Table 2 presents the contextual and clinical variables of the patients, with 216 (55.2%) of the patients having been enrolled on NHIS within less than 6 years. About two-thirds of the patients, 256 (65.5%) had visited the hospital between one and three times within the last year. Furthermore, the travel time to the hospital by the respondents was within 1 to 23 minutes for 273 (69.8%). Also, 249 (63.7%) of the respondents waited between 1 and 15 minutes before accessing care, with a median (range) waiting time of 10 (1 – 300) minutes. The majority, 374 (95.7%) indicated their willingness to return to the NHIS Clinic for treatment, while only 65 (16.6%) indicated their willingness to pay out-of-pocket for the same service at the hospital.
Table 2:
Contextual and clinical variables of respondents
| Variable | Frequency (N= 391) | Percentage (%) |
|---|---|---|
| Duration in NHIS (in years) | ||
| 1- 6 | 216 | 55.2 |
| ˃ 6 | 175 | 44.8 |
| Number of Hospital visits in the last 1 year | ||
| 1 – 3 | 256 | 65.5 |
| ˃ 3 | 135 | 34.5 |
| Travel time (in minutes) | ||
| 1 – 23 | 273 | 69.8 |
| ˃ 23 | 118 | 30.2 |
| Waiting time (in minutes) | ||
| 1 - 15 | 249 | 63.7 |
| ˃15 | 142 | 36.3 |
| Median (Range) | 10 (1 - 300) | |
| Willingness to return to NHIS for treatment | ||
| Yes | 374 | 95.7 |
| No | 17 | 4.3 |
| Will you prefer to pay out-of-pocket for the same service at the hospital | ||
| Yes | 65 | 16.6 |
| No | 326 | 83.4 |
| If you were to contribute from your monthly income to NHIS, are you willing to | ||
| Yes | 111 | 28.4 |
| No | 280 | 71.6 |
Table 3 presents the patients' level of satisfaction with the NHIS clinic. 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. Domains related to finances and time spent with the doctor and general satisfaction had the lowest scores (74.4±12.8, 74.2±12.5 and 69.8±13.3 respectively).
Table 3:
Patients’ satisfaction with quality of care
| Patients’ satisfaction domain | Raw score (Mean±SD) | Maximum obtainable raw score | Patients’ satisfaction Score (Mean±SD) |
|---|---|---|---|
| General Satisfaction | 6.98 ± 1.33 | 10.00 | 69.8 ± 13.3 |
| Technical Quality | 14.82 ± 1.98 | 20.00 | 74.1 ± 9.90 |
| Interpersonal Manner | 7.96 ± 1.00 | 10.00 | 79.6 ± 10.0 |
| Communication | 7.85 ± 1.16 | 10.00 | 78.5 ± 11.6 |
| Financial Aspects | 7.44 ± 1.28 | 10.00 | 74.4 ± 12.8 |
| Time Spent with Doctor | 7.42 ± 1.25 | 10.00 | 74.2 ± 12.5 |
| Accessibility and Convenience | 15.06 ± 1.91 | 20.00 | 75.3 ± 9.55 |
| Overall satisfaction | 67.52 ± 5.73 | 90.00 | 75.02 ± 6.37 |
Table 4 presents the factors (sociodemographic, contextual and clinical) associated with overall satisfaction. There was a significant association (p < 0.001) between travel time and overall satisfaction. Notably, greater satisfaction levels were substantially associated with both readiness to return to the clinic (p = 0.001). Most factors in Table 4 did not show significant association with overall satisfaction (p > 0.05), including age, sex, education, marital status, religion, length of time in NHIS, number of hospital visits, waiting time, referral history, preference to pay out-of-pocket, and willingness to contribute to NHIS.
Table 4:
Association between patient satisfaction score and socio-demographic and contextual factors
| Variable | Patient Satisfaction Score Mean ± SD | Test | P-value |
|---|---|---|---|
| Age (in years) | 0.156F | 0.856 | |
| ≤ 44 years | 75.12 ± 6.353 | ||
| 45-64 years | 75.00 ± 7.028 | ||
| ≥ 65 years | 74.52 ± 4.639 | ||
| Sex | -0.309T | 0.757 | |
| Male | 74.93 ± 6.656 | ||
| Female | 75.13 ± 6.048 | ||
| Highest level of Education | 0.296F | 0.744 | |
| Up to Secondary | 75.52 ± 6.988 | ||
| Tertiary | 74.98 ± 6.243 | ||
| Others | 74.25 ± 6.841 | ||
| Marital Status | 1.253F | 0.287 | |
| Never married | 74.15 ± 6.315 | ||
| Married | 75.32 ± 6.381 | ||
| Divorced/Widowed/Separated | 74.19 ± 6.266 | ||
| Religion | -0.142T | 0.887 | |
| Christianity | 75.01 ± 6.495 | ||
| Islam | 75.12 ± 5.631 | ||
| Tribe | 3.872F | 0.022 | |
| Yoruba | 75.19 ± 6.418 | ||
| Igbo | 75.52 ± 6.230 | ||
| Others | 71.41 ± 4.947 | ||
| Main occupation | 1.585F | 0.150 | |
| Trader | 75.03 ± 4.911 | ||
| Farmer | 73.92 ± 7.089 | ||
| Artisan/Technician | 74.35 ± 3.263 | ||
| Civil Servant | 75.60 ± 6.569 | ||
| Professional | 72.68 ± 7.945 | ||
| Student | 72.62 ± 5.589 | ||
| Others | 75.23 ± 6.268 | ||
| Household size | -1.355T | 0.178 | |
| ≤ 5 | 74.76 ± 5.865 | ||
| ˃ 5 | 76.06 ± 8.004 | ||
| Duration in NHIS (in years) | -0.852T | 0.395 | |
| 1-6 years | 74.78 ± 6.554 | ||
| ˃ 6 years | 75.33 ± 6.130 | ||
| Number of Hospital visits in the last 1 year | 1.297T | 0.196 | |
| 1-3 | 75.32 ± 6.592 | ||
| ˃ 3 | 74.47 ± 5.897 | ||
| Travel time (in minutes) | -4.063T | ˂ 0.001 | |
| 1-23 | 74.18 ± 6.212 | ||
| ˃ 23 | 76.99 ± 6.309 | ||
| Waiting time (in minutes) | -0.718T | 0.474 | |
| 1-15 mins | 74.82 ± 5.157 | ||
| ˃ 15 mins | 75.37 ± 8.070 | ||
| Have you ever been referred to NHIS facility | 1.538T | 0.128 | |
| Yes | 76.30 ± 6.960 | ||
| No | 74.80 ± 6.241 | ||
| Willingness to return to NHIS for treatment | 3.770T | 0.001 | |
| Yes | 75.26 ± 6.294 | ||
| No | 69.80 ± 5.817 | ||
| Will you prefer to pay out-of-pocket for the same service at the hospital | -0.605T | 0.546 | |
| Yes | 74.59 ± 6.170 | ||
| No | 75.11 ± 6.409 | ||
| If you were to contribute from your monthly income to NHIS, are you willing to | 1.010T | 0.314 | |
| Yes | 75.54 ± 6.266 | ||
| No | 74.82 ± 6.405 |
F: ANOVA, T: independent student-t-test
Table 5 shows the predictors of patient satisfaction scores. Patients with travel time of more than 23 minutes travel time had about a 0.18 increase in their satisfaction score than patients with lesser travel time after controlling for other variables (B = 0.175; 95% CI = 1.065 – 3.796). Also, patients who are unwilling to return to NHIS for treatment had about a 0.16 decrease in their satisfaction score than those willing to return to NHIS for treatment after controlling for other variables (B = -0.159; 95% CI = -7.979 – -1.965). Other variables were not significant predictors of patient satisfaction.
Table 5:
Multiple linear regression analysis showing predictors of patient satisfaction
| Variable | Standardized Beta-coefficients | p-value | 95.0% Confidence Interval for Beta-coefficient | |
|---|---|---|---|---|
| Lower Bound | Lower Bound | |||
| Tribe | ||||
| Yoruba (Reference) | ||||
| All others | -0.030 | 0.547 | -2.016 | 1.070 |
| Main occupation | ||||
| Civil Servant (Reference) | ||||
| All others | -0.088 | 0.078 | -2.417 | 0.130 |
| Household size | ||||
| ≤ 5 (Reference) | ||||
| ˃ 5 | 0.061 | 0.218 | -0.574 | 2.503 |
| Number of Hospital visits in the last 1 year | ||||
| 1-3 (Reference) | ||||
| ˃ 3 | -0.073 | 0.139 | -2.278 | 0.318 |
| Travel time (in minutes) | ||||
| 1-23 (Reference) | ||||
| ˃ 23 | 0.175 | 0.001 | 1.065 | 3.796 |
| Have you ever been referred to NHIS facility | ||||
| Yes (Reference) | ||||
| No | -0.038 | 0.456 | -2.465 | 1.108 |
| Willingness to return to NHIS for treatment | ||||
| Yes (Reference) | ||||
| No | -0.159 | 0.001 | -7.979 | -1.965 |
Discussion
This study showed a high level of satisfaction with the NHIS clinic services with a satisfaction score of 75.02. Previous studies done in Minna reported an overall satisfaction score of 75.8% [21]; in Enugu 73.1% was reported [16]; a study in Umuahia reported overall score of 66.8% [22]; another study done among 421 NHIS enrollees in Keffi reported a score of 63.1% [7]. Likewise, the high rate of satisfaction with services within NHIS clinic reported in our study agrees with other international studies including a study done in Ghana, in Romania and in South Korea also corroborated high overall patient satisfaction score [23-25]. Interestingly, satisfied patients were more likely to comply with treatment, keep follow up appointments, and utilize healthcare services [9,10].
This study also revealed that the interpersonal domain, which expresses the friendly and courteous way healthcare providers render services to patients, is the best performer with a score of 79.6. This domain embodies the dignity of patients and is regarded as an important component of qualitative healthcare service [26]. Similarly, in keeping with previous studies patients also contentedly rated this domain highest [16,27-28]. Hence, the discovery of this study shows that patients had favorable experiences and were treated with respect by healthcare providers at the NHIS clinic at Federal Teaching Hospital, Ido-Ekiti. Furthermore, the communication domain in this study earns a high performing score of 78.5. This is consistent with findings of previous studies [26,29,30]. However, a previous study in Zaria reported patient’s displeasure with the domain. The study opined that healthcare providers did not listen with adequate concern about their illness and not always availing them enough chance to ask to follow up questions [31]. This could be explained by the differences in the level of education of our respondents and the Zaria study.
The association between patient satisfaction levels and readiness to return to the clinic for treatments was statistically significant (p = 0.001). This finding is in keeping with a study among 163 patients at Viettiep hospital, Haiphong city, Vietnam where there was significant association between the willingness to return for future rehabilitation and patient’s satisfaction especially with the accessibility, equipment and infrastructure, quality of care and treatment and cost of treatment [32]. Additionally, our finding agrees with another study done to determine the relationship between ambulatory patient’s satisfaction with care and their willingness to adhere to the surgeons’ recommendations in the surgical outpatient clinic of the University College Hospital, Ibadan. Significant relationship also existed with willingness to accept follow-up visits (p = 0.002), drug prescription (p <0.001), and further investigation (p <0.001) [33]. This is not unexpected as our study also reported high score domains of accessibility & convenience (75.3) and technical quality (74.1) respectively which strongly supports the readiness of patients to return to our NHIS clinic.
The study revealed a significant association between longer travel time and satisfaction ratings (p < 0.001). The correlation between shorter journey times and higher satisfaction levels emphasizes how accessibility affects patient experiences, as reported in previous studies which shows that patient satisfaction is positively impacted by greater accessibility to healthcare [34-37]. This study revealed that more than two-thirds of respondents reportedly travelled between 1 and 23 minutes to the clinic, implying good geographical accessibility of healthcare services, since the majority of the clients were also staff of the hospital. However, we recorded higher satisfaction levels with those who travel longer distances. The reason for this disparity may be that those who travel longer distance, who apparently are not staff of the hospital, value the health care services more.
The study assessed the relationship between satisfaction levels and sociodemographic and other independent variables showing that age, sex, education, marital status, religion, number of hospital visits, waiting period, referral history, length of time in NHIS, preference for paying out-of-pocket, willingness to contribute to NHIS, and waiting time do not significantly affect satisfaction scores (p > 0.05). This suggests that, in the context of the NHIS clinic, patient satisfaction is not greatly impacted by these conventional demographic characteristics [38]. While these findings emphasize the context-specific nature of the factors that influence patient satisfaction, they are in line with certain previous studies [39-41]. These findings also resonate with previous studies’ findings on the differences in the impact of sociodemographic factors on satisfaction levels in different healthcare settings [42-45]. Understanding these intricacies is essential to tailoring treatments to the unique needs and expectations of the NHIS clinic's patient population [46]. The strength of this study is in the sample size which is good enough to make the statistical assumptions and analysis conducted in the study. However, this is a single center study and, therefore should be generalized with caution.
Conclusion and Recommendations
This study found a high level of 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 identified factors significantly associated with patients’ satisfaction. Satisfaction rates do not vary across socio-demographic and contextual factors. However, there is the need for the management of NHIS clinics to continuously improve the quality of healthcare services provided.
Based on the findings, effective communication was recognized as the foundation of a good interpersonal relationship between the healthcare providers and the patients and its strong influence on patient’s satisfactions, good clinical outcomes and willingness to return for treatment. Therefore, the success of the NHIS operations depends largely on the quality of care provided through an all-inclusive communication approach which allows the patients to seek further clarifications through follow up questions. Targeted interventions like training of healthcare workers, supportive supervision and on-site mentoring and technical assistance will be required to improve health workers’ competencies and building their capacity on how to spend quality time informing patients about their diagnosis, the tests ordered and the reasons for ordering the tests while doing these in a polite manner.
Conflict of Interest
The authors have no conflict of interest to declare.
Funding
No external funding from any source was received for the conduct of this study.
References
- 1.National Health Insurance Scheme Membership Handbook, a guide for enrolees on the operations for NHIS formal sector programmes [Assessed February 11, 2022]. Available at https://www.nhis.gov.ng/%3Fmedia_dl%3D2713&sa=U&ved=2ahUKEwibi7SUjon2AhWI3oUKHSVcBRsQFnoECAMQAg&usg=AOvVaw2Aht5LDFB4BuvGm3RyYuK
- 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 [Google Scholar]
- 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. [Google Scholar]
- 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. [Google Scholar]
- 5.Mohammed S, Sambo MN, Dong H. Understanding client satisfaction with a health insurance scheme in Nigeria: factors and enrolees experiences. Health Res Policy Syst 2011; 9:20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 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. [Google Scholar]
- 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. [Google Scholar]
- 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. [PubMed] [Google Scholar]
- 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. [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 12.Cleary PD. The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement. BMJ 1999; 319:720-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 14.Ware JE, Snyder MR, Wright R. Defining and measuring patient satisfaction with medical care. Eval. Prog. Planning, 1983; 6: 247-263. [DOI] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 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) [Google Scholar]
- 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. [Google Scholar]
- 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. [Google Scholar]
- 19.Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex Publishers; 2004. p. 117-20. [Google Scholar]
- 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. [Google Scholar]
- 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. [DOI] [PubMed] [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 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. [Google Scholar]
- 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. [DOI] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 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. [DOI] [PubMed] [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Haruna-Ogun OA. Geographical differentials in uptake of antenatal care services in Nigeria. Health Care Women Int. 2018;39(1):34–49. [DOI] [PubMed] [Google Scholar]
- 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). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [DOI] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 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. [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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. [Google Scholar]
- 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. [DOI] [PMC free article] [PubMed] [Google Scholar]