The effects of National Health Insurance Scheme on equity and quality of diabetes care in secondary healthcare facilities in SouthWest Nigeria

Abstract

There have been concerns about the influence of the National Health Insurance Scheme (NHIS) on equity and quality of diabetes care in many healthcare settings. This study aimed to assess the effects of NHIS on
equity and quality of diabetes care (DC) in Nigeria. A prospective cross-sectional study was carried out among 110 (insured n=42, uninsured=68) consenting type 2-diabetics. Diabetic outpatients on oral hypoglycemic drugs, with at least 4 clinic visits prior to the time of the study were consecutively selected at two NHIS accredited public hospitals in Southwest, Nigeria. Patients’ perceptions of equity and quality of DC were assessed using a validated 27 items questionnaire. The medical care and pharmaceutical care in diabetes were independently assessed using medical chart review and a direct observation of dispensing pharmacists’ activities respectively. Chi-squared test was used to determine associations between variables. Majority (61.8%) of the study participants were uninsured. Females (50.9%) were more than the males (49.1%), 40.0% had post-secondary qualifications. The mean ages for the insured and uninsured were 52.02±11.6 and 58.97± 9.3years respectively. The insured and the uninsured differ in their perceptions of drug availability (p<0.001). The pharmacists’ counselling time (p<0.001) differs between the groups. The quality of medical care provided to the diabetics was generally low. The NHIS did not influence the quality of DC, though it may have engendered inequity in pharmaceutical care in the facilities.

Journal of Medical and Biomedical Sciences (2018) 7(1), 11 - 21