A Preliminary Study on Enrollees Perception and Experiences of National Health Insurance Scheme in Lagos State, Nigeria

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.