Patient satisfaction with the Nigerian National Health Insurance Scheme two decades since establishment: A systematic review and recommendations for improvement

Background: To improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. The NHIS remains Nigeria’s leading vehicle for achieving universal health coverage; nonetheless, questions remain regarding its quality and effectiveness. Studies on patient satisfaction have served as a useful strategy to further understand the patient experience and the efficacy of health systems.Aim: To synthesise current knowledge on patient satisfaction with the NHIS.Methods: The authors performed a systematic review of primary literature from 1999 to 2020 reporting on NHIS patient satisfaction in eight databases (including PubMed, Embase, and Africa-wide Information).Results: This search returned 764 unique records of which 21 met criteria for full data extraction. The 21 qualifying studies representing 11 of the 36 Nigerian states, were published from 2011 to 2020, and found moderate overall satisfaction with the NHIS (64%). Further, when disaggregated into specific domains, NHIS enrolees were most satisfied with provider attitudes (77%) and healthcare environments (70%), but less satisfied with laboratories (62%), billings (62%), pharmaceutical services (56%), wait times (55%), and referrals (51%). Importantly, time trends indicate satisfaction with the NHIS is increasing – although to differing degrees depending on the domain.Conclusion: The beneficiaries of the NHIS are moderately satisfied with the scheme. They consider it an improvement from being uninsured, but believe that the scheme can be considerably improved. The authors present two main recommendations: (1) shorter wait times may increase patient satisfaction and can be a central focus in improving the overall scheme, and (2) more research is needed across all 36 states to comprehensively understand patient satisfaction towards NHIS in anticipation of potential scheme expansion.

Economic Burden of Inpatient Wound Dressing in Nigeria: Implication for Catastrophic Household Expenditure

Background: The literature is replete with family impoverishment resulting from out of pocket healthcare financing on the Africa continent. In Nigeria the healthcare insurance scheme is evolving and requires wider coverage. The aim of this study is to examine catastrophic household expenditure emanating from daily or alternate day wound dressing.Methods. The study was based on a descriptive cross-sectional research design to investigate the economic burden of daily or alternate day wound dressing among hospitalized patients in selected teaching hospitals in south west Nigeria. The inclusion criteria focused on inpatients about to be discharged or already spent minimum of four weeks in hospital. The data collection instrument was pre-tested with a coefficient of stability of 0.774. Respondents were selected via convenience sampling while an interview administered questionnaire was used to elicit information on wound care from patients in medical surgical wards. Covid-19 protocols were strictly adhered to and ethical approval was sought from each hospital.Results: The result revealed that the mean age of the respondents was 44.95 ± 16.12. Two-thirds were men who are artisans and traders with only secondary school education. Over 70% of the respondents have between 5 and 10 family members, more than 50% earn less than ₦50000 per month. The majority have no comorbidities (79.5%), about 50% were on daily dressing which required 1–5 moderate or major dressing packs per week. The length of hospital stay for the majority of the respondents (85.3%) was less than 11 weeks.Conclusions: The daily or alternate day wound dressing requires a financial input beyond the coping capacity of the indigenous Nigerian families. The Nigerian government should scale up coverage of health insurance scheme to cover artisans, small traders and other low income earners to reduce the incidence of catastrophic household expenditure.

The Australian National Disability Insurance Scheme and People With Disabilities From CALD Backgrounds

The National Disability Insurance Scheme (NDIS) is considered to be the second greatest reform in healthcare in Australia after the introduction of Medicare in Australia in 1983. This reform was introduced in 2012 in two phases. The first phase as a trial took place for three years. The expectation was that the reform will be rolled out by 2019 or 2020. This article argues that the trial implementation process has achieved very positive outcomes in the lives of a great number of people with disability in Australia. At the same time, NDIS is facing many serious challenges in some areas. One of the obvious challenges is that this reform is a market approached reform. The second challenge relates to meeting the needs of minorities. People with disabilities from Culturally and Linguistically Divers (CALD) backgrounds are one of the five most venerable, underutilised users of NDIS services in Australia. They have no strong voice and negotiable abilities. The main question here is how NDIS is to meet its commitment to satisfy the needs of these vulnerable people in Australia.

Auditory performance and speech intelligibility among children with cochlear implant under a state-sponsored insurance scheme: a cross-sectional study

Background: Cochlear implant is the intervention for improving the auditory performance and speech ability for children between 6-12 years with congenital deafness under the Chief Minister’s Comprehensive Health Insurance Scheme, a state-sponsored insurance scheme in Tamil Nadu. Until 2020, 4107 children had been provided with a cochlear implant under the scheme. However, the outcome of this intervention was not studied so far. Hence, as a program evaluation auditory performance and speech intelligibility among patients who received cochlear implant under the scheme is studied.Methods: A cross-sectional study was conducted among 203 patients who had received a cochlear implant at least 1 year ago. Children were evaluated for auditory performance and speech intelligibility using revised Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores by trained speech therapists in Government Medical College hospitals. The proportion of good scorers in CAP (level ≥7) and SIR (category ≥ 3) was computed. The difference in proportion between different demographics was tested using the Chi-square test and Fischer exact test.Results: The median CAP and SIR scores of the children were 8 (Interquartile Range – 4) and 3 (IQR – 2) respectively. Almost 2/3rd of the children had good auditory performance and speech intelligibility. Factors that were associated with good auditory performance and speech intelligibility were being a girl child, getting the implant before 3 years of age, and getting it in a private institution.Conclusions: Gender and age at implant influences auditory performance and speech intelligibility after cochlear implant. Hence, early screening for deafness should be made a routine to enable early detection and management, thereby preventing permanent disability.

European Deposit Insurance Scheme(s) – Consequences for the EU’s Financial Stability

The aim of this paper is to evaluate the potential consequences that the shortcomings in harmonising the national deposit guarantee schemes may have on the financial stability of the European Union. The relevance of this subject is underlined both by the European Commission’s intention to revive the European Deposit Insurance Scheme project in 2021 and the recent signals from Germany that they are willing to support the initiative. The paper presents a review of the discussions on establishing a European Deposit Insurance Scheme, the reasons for the project’s failure and the consensus solution that took the form of the Deposit Guarantee Scheme Directive (DGSD). The limited scope of deposit guarantee scheme harmonisation under this directive is discussed in the context of the related EBA opinions pointing to different areas of potential improvements. Differences in national implementation are also reviewed in terms of their potential impact on financial stability. Apart from a careful literature review, statistical analysis of the available financial information characterizing the largest national deposit schemes of the euro is performed to quantify their progress towards the target level of the available financial means. The results prove that most national schemes are still far from reaching the 0.8% target level of readily available funds and that potentially desirable amendments to the DGSD may drag them even further away from reaching that target by 2024. The author concludes that from the perspective of financial stability, the EU should focus on establishing a single scheme at an international level that would complete the project of establishing a banking union. The results contribute to the ongoing discussion on the need to further integrate the national deposit guarantee schemes inside the EU.

Is value-based payment for healthcare feasible under Ghana’s National Health Insurance Scheme?

Background Effective payment mechanisms for healthcare are critical to the quality of care and the efficiency and responsiveness of health systems to meet specific population health needs. Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has adopted fee-for-service, diagnostic-related groups and capitation methods, which have contributed to provider reimbursement delays, rising costs and poor quality of care rendered to the scheme’s clients. The aim of this study was to explore stakeholder perceptions of the feasibility of value-based payment (VBP) for healthcare in Ghana. Value-based payment refers to a system whereby healthcare providers are paid for the value of services rendered to patients instead of the volume of services. Methods This study employed a cross-sectional qualitative design. National-level stakeholders were purposively selected for in-depth interviews. The participants included policy-makers (n = 4), implementers (n = 5), public health insurers (n = 3), public and private healthcare providers (n = 7) and civil society organization officers (n = 1). Interviews were audio-recorded and transcribed. Data analysis was performed using both deductive and inductive thematic analysis. The data were analysed using QSR NVivo 12 software. Results Generally, participants perceived VBP to be feasible if certain supporting systems were in place and potential implementation constraints were addressed. Although the concept of VBP was widely accepted, study participants reported that efficient resource management, provider motivation incentives and community empowerment were required to align VBP to the Ghanaian context. Weak electronic information systems and underdeveloped healthcare infrastructure were seen as challenges to the integration of VBP into the Ghanaian health system. Therefore, improvement of existing systems beyond healthcare, including public education, politics, data, finance, regulation, planning, infrastructure and stakeholder attitudes towards VBP, will affect the overall feasibility of VBP in Ghana. Conclusion Value-based payment could be a feasible policy option for the NHIS in Ghana if potential implementation challenges such as limited financial and human resources and underdeveloped health system infrastructure are addressed. Governmental support and provider capacity-building are therefore essential for VBP implementation in Ghana. Future feasibility and acceptability studies will need to consider community and patient perspectives.