Patient satisfaction with the Nigerian National Health Insurance Scheme two decades since establishment: A systematic review and recommendations for improvement

• Type of Material: Article
• Authors: Onyemaechi Nwanaji-Enwerem, Duke University; Paul Bain, Harvard Medical School; Zoe Marks, John F. Kennedy School of Government; Pamaji Nwanaji-Enwerem, Barber-Scotia College; Catherine Staton, Duke University; Ayobami Olufadeji, Harvard Medical School; Jamaji Nwanaji-Enwerem, Emory University
• Language: English
• Date: 2022-01-01
• Publisher: AOSIS Publishing
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Onyemaechi Nwanaji-Enwerem, Paul Bain, Zoe Marks, Pamaji Nwanaji-Enwerem, Catherine A. Staton, Ayobami Olufadeji, Jamaji C. Nwanaji-Enwerem.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4102/phcfm.v14i1.3003
• Title of Journal or Parent Work: African Journal of Primary Health Care and Family Medicine
• Volume: 14
• Issue: 1
• Start Page: e1
• End Page: e10
• Grant/Funding Information: Publication was made possible in part by support from the Berkeley Research Impact Initiative (BRII) sponsored by the UC Berkeley Library.
• Keywords: Ghana; National Health Programs; patient satisfaction; Universal Health Insurance; Patient Satisfaction; systematic review; Insurance, Health; SDG 2030; health insurance; Humans; Health Services Accessibility; Nigeria; NHIS
• Research Categories: Sociology, Public and Social Welfare; Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Background To improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. The NHIS remains Nigeria’s leading vehicle for achieving universal health coverage; nonetheless, questions remain regarding its quality and effectiveness. Studies on patient satisfaction have served as a useful strategy to further understand the patient experience and the efficacy of health systems. Aim To synthesise current knowledge on patient satisfaction with the NHIS. Methods The authors performed a systematic review of primary literature from 1999 to 2020 reporting on NHIS patient satisfaction in eight databases (including PubMed, Embase, and Africa-wide Information). Results This search returned 764 unique records of which 21 met criteria for full data extraction. The 21 qualifying studies representing 11 of the 36 Nigerian states, were published from 2011 to 2020, and found moderate overall satisfaction with the NHIS (64%). Further, when disaggregated into specific domains, NHIS enrolees were most satisfied with provider attitudes (77%) and healthcare environments (70%), but less satisfied with laboratories (62%), billings (62%), pharmaceutical services (56%), wait times (55%), and referrals (51%). Importantly, time trends indicate satisfaction with the NHIS is increasing – although to differing degrees depending on the domain. Conclusion The beneficiaries of the NHIS are moderately satisfied with the scheme. They consider it an improvement from being uninsured, but believe that the scheme can be considerably improved. The authors present two main recommendations: (1) shorter wait times may increase patient satisfaction and can be a central focus in improving the overall scheme, and (2) more research is needed across all 36 states to comprehensively understand patient satisfaction towards NHIS in anticipation of potential scheme expansion.