Satisfaction with quality of care: a comparative study of National Health Insurance Scheme and non-National Health Insurance Scheme patients of a tertiary hospital in South-Eastern Nigeria

Abstract

Background: The current trend towards consumer satisfaction driven healthcare services have been viewed as the compass for assessing quality of care in hospitals. 
Aim: To compare satisfaction with quality of care received by national health insurance scheme (NHIS) and non-national health insurance scheme (non-NHIS) patients of a tertiary hospital in South- Eastern Nigeria.
Methods: A comparative cross sectional study carried out on 400 NHIS and 400 non-NHIS patients from April 2011 to October 2011 at the Department of Family Medicine of Federal Medical Centre, Umuahia.  Adult patients seen within the study period who met the inclusion criteria were selected by systematic sampling using every second patient that registered to see the clinicians.  Data were collected using pretested, structured interviewer-administered questionnaire. Each satisfaction item was scored on a five points Likert scale ordinal response which was converted to percentages.
Results: The overall average satisfaction score of the NHIS respondents was significantly higher than that for non-NHIS (66.8% vs 62.0%)(p=0.04). The NHIS respondents' satisfaction with patient-provider relationship (81.5% vs 78.0%) (p=0.062), patient-provider communication(79.9% vs 76.0%)(p=0.070) and accessibility(74.2% vs 72.8%)(p=0.072) were higher than that of non-NHIS patient. These relative differences were not statistically significant.  NHIS patients' satisfaction with waiting time (48.3% vs 48.0%)(p=0.224) and hospital bureaucracy (48.8% vs 47.0%)(p=0.213) were higher than that of non-NHIS patients. This difference was also not statistically significant.
Conclusion: Overall NHIS respondents' satisfaction with the services provided was significantly higher than non-NHIS patients. There is need to improve on the current level of satisfaction in addition to addressing the identified domains of dissatisfaction with quality of care.

Keywords: Comparative satisfaction, NHIS, Non-NHIS, Patients, Nigeria, Tertiary hospital