Awareness, knowledge and perceptions of physicians of the National Health Insurance Scheme in Nigeria: An exploratory study

Abstract

Nigeria implemented a National Health Insurance Scheme (NHIS) in 2005, introducing monumental changes to the health care delivery system. This study assessed physicians’ understanding of the objectives of the NHIS as well as their perceptions of the scheme, to identify their level of acceptance and support of the health policy reform. A convenient sample of 134 physicians residing in South-East Nigeria were surveyed via a self-administered questionnaire. Descriptive statistics were used to summarize study data. Aggregate knowledge scores regarding health insurance and the NHIS objectives were assessed. Measures of consensus (Cns) of physicians’ perceptions of the health reform were also obtained. Study results show a high level of awareness and support for the NHIS among participants. However, there were deviations between awareness of the NHIS and knowledge of the program’s objectives. Aggregate knowledge scores differed significantly by age group, length of years of practice, place of employment and location. Further, consensus measures of physician’s perceptions of NHIS (Cns index = 0.69) and the introduction of Health Maintenance Organizations (HMOs) as intermediary operators of the scheme (Cns index = 0.68) were positive and considered strong while perceptions on associations between HMOs and corruption in the country was moderate (Cns index = 0.56) and slightly negative. This study demonstrates physicians’ support for the NHIS program in Nigeria and an acceptance of changes implemented with the health policy reform. Knowledge gaps were identified, highlighting the need for increased awareness of the reform and its objectives.

Keywords

Physicians / Knowledge assessment / National health insurance / Universal coverage / Nigeria

References

[1] Wagstaff A, Cotlear D, Eozenou PH, et al. Measuring progress towards universal health coverage: with an application to 24 developing countries. Oxford Rev. Econ. Policy. 2016; 32(1): 147-89. https://doi.org/10.1093/oxrep/grv019

[2] Lagomarsino G, Garabrant A, Adyas A, et al. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. The Lancet. 2012; 380(9845): 933-43. PMid:22959390. https://doi.org/10.1016/S0140-6736(12)61147-7

[3] Boerma T, Eozenou P, Evans D, et al. Monitoring progress towards universal health coverage at country and global levels. PLoS Med. 2014; 11(9): e1001731. PMid:25243899. https://doi.org/10.1371/journal.pmed.1001731

[4] Whynes DK, Baines DL. Primary care physicians’ attitudes to health care reform in England. Health Policy. 2002; 60(2): 111-32.PMid:11897372. https://doi.org/10.1016/S0168-8510(01)00188-9

[5] McCormick D, Himmelstein DU, Woolhandler S, et al. Single-payer national health insurance: physicians’ views. Arch. Intern. Med. 2004; 164(3): 300-4. PMid:14769625. https://doi.org/10.1001/archinte.164.3.300

[6] Umeh JC, Freeman RA, Garner DD, et al. Attitudes of Nigerian physicians toward a national health service. Soc. Sci. Med. 1986; 23(7): 701-8. PMid:3775452. https://doi.org/10.1016/0277-9536(86)90118-8

[7] Beecham L. Most GPs would consider resigning from NHS. BMJ. 2001; 322(7299): 1381. PMid:11397731. https://doi.org/10.1136/bmj.322.7299.1381

[8] Freeborn DK. Satisfaction, commitment, and psychological wellbeing among HMO physicians. West. J. Med. 2001; 174(1): 13.PMid:11154654. https://doi.org/10.1136/ewjm.174.1.13

[9] Umeh CA. Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania. Int J Health Plann Manage. 2018; 33(4): 794-805. PMid:30074646. https://doi.org/10.1002/hpm.2610

[10] Okebukola PO, Brieger WR. Providing universal health insurance coverage in Nigeria. Int. Q. Community Health Educ. 2016; 36(4):241-6. PMid:27389041. https://doi.org/10.1177/0272684X16657451

[11] NHIS_OPERATIONAL_GUIDELINES-National Health Insurance Scheme.https://www.nhis.gov.ng/2020/11/19/nhis_operational_guidelines/. Published 2012 (Updated 2020). Accessed January 24, 2022.

[12] Onoka CA, Hanson K, Mills A. Growth of health maintenance organisations in Nigeria and the potential for a role in promoting universal coverage efforts. Soc. Sci. Med. 2016; 162: 11-20. PMid:27322911.https://doi.org/10.1016/j.socscimed.2016.06.018

[13] Garland R. The mid-point on a rating scale: Is it desirable. Marketing Bulletin. 1991; 2(1): 66-70.

[14] Barakji FA. Scales, Forced Choice. In: MikeAllen, Editor. The SAGE Encyclopedia of Communication Research Methods. Vol4. Thousand Oaks, Inc; CA: SAGE Publications, 2017. 1552-4 p.

[15] Tastle WJ, Wierman MJ. Consensus and dissention: A measure of ordinal dispersion. Int J Approx Reason. 2007; 45(3): 531-45.https://doi.org/10.1016/j.ijar.2006.06.024

[16] Ilochonwu NA. Awareness and Perception of Resident Doctors towards National Health Insurance Scheme in a Tertiary Hospital. TNHJ. 2018; 17(2): 17-27.

[17] Adeniyi AA, Onajole AT. The National Health Insurance Scheme (NHIS): a survey of knowledge and opinions of Nigerian dentists in Lagos. Afr J Med Med Sci. 2010; 39(1): 29-35. PMid:20632669.

[18] Okaro AO, Ohagwu CC, Njoku J. Awareness and perception of national health insurance scheme (NHIS) among radiographers in south east Nigeria. Am. J. Sci. Res. 2010; 8(1): 18-25.

[19] Abiola AO, Ladi-Akinyemi TW, Oyeleye OA, et al. Knowledge and utilisation of National Health Insurance Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria. Afr. J. Prim. Health Care Fam. Med. 2019; 11(1): 1-7. PMid:31588768. https://doi.org/10.4102/phcfm.v11i1.2018

[20] Olugbenga-Bello AI, Adebimpe WO. Knowledge and attitude of civil servants in Osun state, Southwestern Nigeria towards the national health insurance. Niger. J. Clin. Pract. 2010; 13(4): 421-6.PMid:21220858.

[21] Sanusi RA, Awe AT. Perception of national health insurance scheme (NHIS) by health care consumers in Oyo state, Nigeria. PJSS. 2009; 6(1): 48-53.

[22] Davies P, Carrin G. Risk-pooling-necessary but not sufficient. Bulletin-World Health Organization. 2001; 79(7): 587.PMid:11477960.

[23] Bartholomae S, Russell MB, Braun B, et al. Building health insurance literacy: evidence from the Smart Choice Health InsuranceTM program. J Fam Econ Issues. 2016; 37(2): 140-55. https://doi.org/10.1007/s10834-016-9482-7

[24] Tabor SR. Community-based health insurance and social protection policy. World Bank, Washington: Social Protection Discussion Paper Series; 2005 Mar 1.

[25] Alubo O. The promise and limits of private medicine: health policy dilemmas in Nigeria. Health Policy Plan. 2001; 16(3): 313-21.PMid:11527872. https://doi.org/10.1093/heapol/16.3.313

[26] Agyei-Baffour P, Oppong R, Boateng D. Knowledge, perceptions and expectations of capitation payment system in a health insurance setting: a repeated survey of clients and health providers in Kumasi, Ghana. BMC Public Health. 2013; 13(1): 1-9. PMid:24359034.https://doi.org/10.1186/1471-2458-13-1220

[27] Bodenheimer T. High and rising health care costs. Part 3: the role of health care providers. Ann. Intern. Med. 2005; 142(12_Part_1):996-1002. PMid:15968014. https://doi.org/10.7326/0003-4819-142-12_Part_1-200506210-00009

[28] Robinson JC. Theory and practice in the design of physician payment incentives. Milbank Q. 2001; 79(2): 149-77. PMid:11439463.https://doi.org/10.1111/1468-0009.00202

[29] Bodenheimer TS, Grumbach K. Capitation or decapitation: keeping your head in changing times. JAMA. 1996; 276(13): 1025-31. PMid:8847754. https://doi.org/10.1001/jama.1996.03540130023011

[30] Robyn PJ, Sauerborn R, Bärnighausen T. Provider payment in community-based health insurance schemes in developing countries:a systematic review. Health Policy Plan. 2013; 28(2): 111-22.PMid:22522770. https://doi.org/10.1093/heapol/czs034

[31] Christina CP, Latifat TT, Collins NF, et al. National health insurance scheme: How receptive are the private healthcare practitioners in a local government area of Lagos state. Nigerian Medical Journal:Journal of the Nigeria Medical Association. 2014; 55(6): 512.PMid:25538373. https://doi.org/10.4103/0300-1652.144712

[32] Laugesen MJ. Civilized medicine: physicians and health care reform. J Health Polit Policy Law. 2011; 36(3): 507-12. PMid:21673254.https://doi.org/10.1215/03616878-1271171

[33] Antiel RM, Curlin FA, James KM, et al. Physicians’ beliefs and US health care reform-a national survey. N. Engl. J. Med. 2009; 361(14):e23. PMid:19752464. https://doi.org/10.1056/NEJMp0907876

[34] Deom M, Agoritsas T, Bovier PA, et al. What doctors think about the impact of managed care tools on quality of care, costs, autonomy,and relations with patients. BMC Health Serv. Res. 2010; 10(1): 1-8. PMid:21138576. https://doi.org/10.1186/1472-6963-10-331

[35] Okonkwo A. Abuja Nigeria set to launch health insurance scheme. The Lancet. 2001; 358(9276): 131. https://doi.org/10.1016/S0140-6736(01)05388-0

[36] Katibi IA, Akande AA, Akande TM. Awareness and attitude of medical practitioners in Ilorin towards the National Health Insurance Scheme. Sahel Med. J. 2003; 6(1): 14-6. https://doi.org/10.4314/smj2.v6i1.12819

[37] Sadiq MY, Abdullahi M. Corruption as the bane of Nigeria’s development:Causes and remedies. J Int Trade Econ Dev. 2013; 4(1):83-93.

[38] Fisher RJ, Katz JE. Social-desirability bias and the validity of self-reported values. Psychol Mark. 2000; 17(2): 105-20. https://doi.org/10.1002/(SICI)1520-6793(200002)17:2<105::AID-MAR3>3.0.CO;2-9.