Review Article

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

Onyemaechi Nwanaji-Enwerem, Paul Bain, Zoe Marks, Pamaji Nwanaji-Enwerem, Catherine A. Staton, Ayobami Olufadeji, Jamaji C. Nwanaji-Enwerem
African Journal of Primary Health Care & Family Medicine | Vol 14, No 1 | a3003 | DOI: https://doi.org/10.4102/phcfm.v14i1.3003 | © 2022 Onyemaechi Nwanaji-Enwerem, Paul Bain, Zoe Marks, Pamaji Nwanaji-Enwerem, Catherine A. Staton, Ayobami Olufadeji, Jamaji C. Nwanaji-Enwerem | This work is licensed under CC Attribution 4.0
Submitted: 13 April 2021 | Published: 13 January 2022

About the author(s)

Onyemaechi Nwanaji-Enwerem, Harvard John F. Kennedy School of Government, Cambridge, Massachusetts, United States of America; and, Duke University School of Medicine, Durham, North Carolina, United States of America
Paul Bain, Countway Library, Harvard Medical School, Boston, Massachusetts, United States of America
Zoe Marks, Harvard John F. Kennedy School of Government, Cambridge, Massachusetts, United States of America
Pamaji Nwanaji-Enwerem, Department of Business and Entrepreneurship, Barber-Scotia College, Concord, North Carolina, United States of America
Catherine A. Staton, Division of Emergency Medicine, Duke University, Durham, North Carolina, United States of America
Ayobami Olufadeji, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
Jamaji C. Nwanaji-Enwerem, Gangarosa Department of Environmental Health, Emory Rollins School of Public Health and Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America


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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.


Keywords

Nigeria; health insurance; patient satisfaction; systematic review; NHIS; SDG 2030

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