National Health Insurance Scheme Enrolees’ Satisfaction with Quality of Care and Willingness to Retain Membership in a tertiary hospital in Nigeria: Implications for Community-Based Health Insurance uptake

Abstract

<title>Abstract</title> <bold>Background;</bold> Low enrolment into National Health Insurance scheme is a barrier to universal health coverage in Nigeria and could be connected to consumer/enrolees’ satisfaction which is an important index of willingness to retain any service provider. Therefore, enrolees’ satisfaction with the quality of received healthcare services and willingness to retain membership of NHIS at a tertiary hospital in Ebonyi State, Nigeria was evaluated. <bold>Method:</bold> The embedded nested design was implemented under an integrative mixed-method approach to study 376 NHIS enrolees selected using a convenience sampling technique at Alex Ekwueme University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. Researcher-developed questionnaire and interview guide were used for data collection. Quantitative data were analysed using Z test, at two-tailed p &lt; 0.05 while qualitative data were analysed thematically. <bold>Results:</bold> Proportion of satisfied enrolees (232, 61.70%) was higher than unsatisfied enrolees (Z= 6.42; p = &lt;.0002 two-tailed; 95% CI= 0.16 – 0.30). Reasons for enrolees satisfaction were quick recovery, assurance of receiving unadulterated drugs, easy accessibility to specialized services, and significant healthcare expenditure reduction. Reasons for enrolees unsatisfaction were drug stock-out, poor drug quality, poor accessibility, arduous bureaucracy, poor Information quality and poor attitude of nurses. Proportion of enrolees willing to retain membership of NHIS (312, 61.70%) was higher than unwilling enrolees (18.233, p = &lt;.0002 two-tailed; 95% CI= 0.60 – 0.71). Reasons for enrolees unwillingness to retain membership of NHIS include long waiting times, drug stock-out, arduous bureaucracy, and poor attitude of nursing personnel. There was a strong association between willingness to retain membership of NHIS and enrolees’ satisfaction with the quality of care received (X ² = 121.14, df=1; Crammer’s V = 0.57; P&lt;.0001). <bold>Conclusion:</bold> Most NHIS enrolees are satisfied, but some are unsatisfied as they are impacted by low institutional capacities and organizational weaknesses like long waiting times, drug stock-out, bureaucratic bottlenecks, and poor nurse attitudes, which also hindered their willingness to retain membership of the NHIS. Therefore, data on enrolee satisfaction with care quality is crucial for policy adjustments and preventing poor institutional governance and practices that could hinder NHIS membership retention or uptake.