Assessment of National Health Insurance Scheme’s (NHIS) Effectiveness in a Tertiary Teaching Hospital in Southeast Nigeria

Abstract

Background: The fundamental concept of health insurance is risk sharing and burden bearing. The scheme is undermined by limitations ranging from very frequent use of the services more than necessary by enrollees, to cost escalation, poor management, and skimming. Assessment of services is a quality control measure in patients’ care and service delivery. It helps to identify gaps for improvement of care and services. Objective: This study assessed the effectiveness of NHIS from the perspective of healthcare providers and managers involved in its implementation to understand the nature of services, and gaps with the view to exploring ways of improving its service delivery. Methods: The study was a descriptive cross-sectional survey using focused group discussion guide to extract information from managers and healthcare providers. Structured interview guides were used to conduct key informant interview (KII). Data were summarized using descriptive statistics. Results: The greatest challenge was limited availability of essential drugs (60.0%), followed by inadequate space (40.0%), inadequate number of staff (40.0%) to meet up with the demand of NHIS patients and delay on reimbursement (40.0%). Most of the key informants 6.0 (60%) attested to poor availability of essential drugs. Conclusion: There is the need for an improvement in accessibility and availability of essential drugs in the scheme. Improvement on the quality of services can promote increased enrolment. Findings suggests the need for improved funding, staff training and development, and more investigative studies into the activities and operations of the scheme to positively impact health insurance operations and improve enrolment by clients. Improved funding, provision of adequate space, infrastructure, good monitoring and evaluation system will boost service delivery and promote sustainability.