Beyond Payment: Patient Perceptions of Dignity, Safety, and Empathy in a Nigerian Tertiary Hospital - A Comparative Study of Insured and Uninsured Outpatients

Abstract

Background:  Promoting interpersonal aspects of care, including dignity, safety, and empathy, is fundamental to patient-centered care and strongly influences satisfaction and clinical outcomes. Objectives: This study compared insured and uninsured patients' perceptions of (i) dignity and safety (assurance) and (ii) staff attitude/empathy at the National Hospital Abuja (NHA). Methods: A cross-sectional study was conducted with 300 outpatients. Using a 5-point Likert scale within a structured questionnaire, satisfaction with assurance and empathy was assessed. The Mann-Whitney U test was used to compare scores between insured and uninsured groups. Results: The overall satisfaction scores for assurance (dignity/safety) and empathy (staff attitude) were 3.42 and 3.39, respectively, both interpreted as "satisfactory". Patients felt most dignified and safe with doctors (mean=3.85) and least with laboratory scientists (mean=3.21). There were no statistically significant differences between insured and uninsured patients in their perception of dignity/safety (p=0.096) or staff empathy (p=0.457). A majority of patients in both groups reported that services improved their health (92%) and would recommend the hospital (94%). Conclusion: The findings indicate that the NHA maintains a generally positive and equitable interpersonal environment, where patients feel respected and cared for, regardless of their insurance status. This is a significant strength of the institution. However, the "satisfactory" scores leave room for improvement. Targeted training for all staff, particularly non-physician cadres, on communication, empathy, and patient-centered care is recommended to elevate these scores to "very satisfactory" or "excellently satisfactory” levels.