Abstract:
The National Health Insurance Scheme (NHIS) was introduced to improve access to quality healthcare at affordable cost for Nigerians through various pre-payment systems. Implementation of the scheme has been viewed from different perspectives, with regard to its impact on beneficiaries‟ health in the Federal Universities. The existing literature revealed few evaluative studies on impact of NHIS on its subscribers, though not focused on the quality and affordability of the healthcare services it provided. This study, therefore, evaluated the NHIS in healthcare centres in (FUs) in the south-west, Nigeria with regard to access to quality and affordable healthcare provision.
The study was anchored to Outcome-Based Evaluation Model, and adopted the QUAN- dominant mixed method design using concurrent approach. The population comprised all staff of Federal Universities in the south-west, Nigeria. Three of the six FUs in the south-west that commenced NHIS since 2009 were purposively selected. The FU workers were stratified into subscribers, former subscribers and non-subscribers. The accidental sampling technique was adopted in selecting 223 subscribers while the snowballing was adopted in selecting 124 former subscribers and 91 non-subscribers, making a total of 438 respondents. The six programme managers of NHIS were purposively selected for key Informant Interview. The NHIS Access to and Participation Record Sheet, NHIS Subscribers Expenses on Drugs Record, NHIS Service Quality (r = .98) and NHIS-Subscribers Satisfaction Rating Scales (r = .89) and NHIS Subscribers Medical Expenses Interview Guide were used for data collection. The quantitative data were analysed using descriptive statistics and econometrics, while qualitative data were content analysed.
Access to healthcare services in the three FUs fluctuated (45.85% in 2009, 80.43% in 2011, 72.87% in 2015 and 87.03% in 2018). Majority of subscribers found NHIS services affordable; however availability of required drugs was rated poor (38.2%). Doctors‟ attendance to subscribers‟ medical needs was rated good (61.1%), waiting time for diagnostic services and time of being attended to by para medical staff was rated poor (35.1%). Healthcare services in these universities were 99% consistent with the NHIS minimum standard benchmark. There was increasing trend of staff patronage of accredited healthcare service providers before commencement of NHIS (9.17% in 1999, 9.74% in 2002, 10.40% in 2004 and 10.71% in 2008),
but fluctuated after (7.55% in 2009, 8.26% in 2002, 7.96 in 2014 and 10.04 in 2018). There was decreasing expenditure on drugs when all costs were subjected to yearly inflationary index (34.7% adjusted differential percentage of expenses on drug). Majority of non-subscribers were aware of the necessity for NHIS intervention in healthcare provision, but did not subscribe because they had alternative healthcare services as they believed that NHIS will not deliver on its promise.
The National Health Insurance Scheme was effective in providing affordable healthcare services to subscribed staff of Federal Universities in the south-west, Nigeria. Management of NHIS should increase access to basic healthcare services by making it inclusive for all current staff of universities up to their various retirement ages. Special provision should also be made for ex- staff. Required quality drugs should be provided
