Abstract

The increasing cost of health services and the need for better use of available resources as well as reduction of pocket spending are the major problems of patient – care. For two decades, many African countries including Nigeria and some of its states have introduced health insurance schemes, which have strived to improve health service provision, prevent out of pocket spending and promotes health care utilization.

Kano State Government is amongst the states in Nigeria to start operating Health Insurance Scheme amongst its clients since 2018 after it was passed as a law by Kano State Assembly.

The main objective of the study was to assess the level of patient satisfaction with the services under Kano State Contributory Health Management Agency in Sheikh Muhammad Jidda General Hospital Kano and the study was a cross sectional study. It uses questionnaire to generate required information from a sample of 100 respondents all drawn from the facility clients.

Data obtained was presented as frequencies and percentages. The study revealed high rate of satisfaction (62%) with the scheme among the respondents, Even though, there is lack of knowledge of employer’s contribution of 68.1% and how the contributions were spent with 80% and the research revealed that 56% of the respondents said drugs were insufficient and also 23% of the respondents rated the quality of drugs poor and lastly, in terms of saving out of pocket 67% of the respondent were saved.

The researcher identified lack of knowledge of the cost tantamount to lack of utilization. While good access to care brings client satisfaction with less save out of pocket. However, government should sensitize the public, expand and equip the facility and if possible reduce the cost of additional as a measure to curtail the existing problem. So also the staff should improve their knowledge and services for effective utilization by the clients.

CHAPTR ONE

INTRODUCTION

1.1 Background of the Study

The increasing cost of health services and the need for better use of available resources is a concern for health-care providers (HSIP, 2003). Consequently, it is evident that there is need to measure the efficiency of health care to determine if proper use of available resources is being made. According to Fitzpatrick (1991), patient satisfaction is an important and widely accepted measure of care efficiency. Meeting of clients expectations are assumed to play a role based on whether the outcome is perceived to be satisfactory or unsatisfactory.

Generally, satisfaction is influenced by the degree to which care fulfils expectations (Health Boards Executive, 2003). Crow et al. (2003) identified that satisfaction was linked to prior satisfaction with health care in the granting of patients desires. One of the most important health factors identified to affect satisfaction is the patient-provider relationship including information and technical competence.

Health insurance schemes have been widely introduced during this last decade in many African countries, which have strived for improvements in health service provision and the promotion of health care utilization. In most developed countries like United States of America, States have been working to promote equal access to health services through insurance coverage by exceeding federal minimums in public health insurance programs, funding their own programs, and regulating the insurance marketplace (Catherine et al, 2008).

These schemes in many low and middle income countries, most especially in the African continent, are still in their early stages of implementation with the goal of universal coverage of the population (Mohammed et al. 2011). In countries such as Ghana and Nigeria, a fixed fee for service known as a user charge, is used by government health facilities, both as a means of raising revenue and as a means of discouraging what may be viewed as ‘unnecessary demand’.

This form of health care financing has a number of disadvantages. The direct payment of fees for service is regressive in that it causes the greatest hardship for the poor, and may cause major difficulties in payment for waged laborers, who are unpaid during sickness.

1.2 The Research Problem

The concept of health insurance scheme is very important most especially among the poor and vulnerable groups (Mclntyre, 2007). In Nigeria, it is implemented as part of health care reform programs and strategies aimed towards providing effective and efficient healthcare for citizens and there is clear lack of universal coverage of health care and equity.

Access to healthcare is severely limited in Nigeria (Otuyime, 2001). Insurance by its nature is expected to enhance access to health and provide financial risk protection to the persons under it. Client satisfaction is a product of good services and consequentially an attraction for more enrollments.

In Nigeria, not much has been documented on whether clients using the health insurance services are getting the needed satisfaction or not especially at state and local government levels.  The study therefore seeks to assess patient satisfaction with services under the health insurance law enacted by Kano State Government.

1.3 Rationale of the Study

Since Insurance by its nature is expected to enhance access to health and provide financial risk protection to the persons under it. The rationale for this research was to make a survey on patient satisfaction, why because, before the commencement of the ongoing Kano State Contributory Health Management Scheme, more than two third of the total civil servants both at state and local government were not in support of it with different reasons; such as earning of very small salary and government refuse to increase the salary for almost one decade (at 18,000 Naira minimum wage), although Nigerian Government has endorsed the new minimum wage of 30,000 Naira but yet to be implemented by most of the state and local government.

Some are patients complaining that, the amount to be deducted from their minuend salary is very high when compared with what is been paid by the civil servants at federal government and the services that are receiving (Federal Government Civil Servant) in terms of quality, efficiency and effectiveness is incomparable because they are mostly enrolled at specialist and tertiary hospitals whereas state and Local Government owned few General and Specialist Hospitals and fully occupied with bunches of primary health care facilities with poor structures and unqualified health personal and at other hand, some people have good perception on it prior to its commencement and till now and some opinion might chance and vice versa.

With this few aforementioned opinions of both the state and local government civil servant of Kano State, the researcher decided to conduct a research in order to assess the condemnation by most of the beneficiaries before the commencement of this program or otherwise, by assessing patient satisfaction with services under the new health insurance law enacted by Kano State Government: An experiences from Sheikh Muhammad Jiddah General Hospital Kano State, Northern Nigeria.

1.4 Main Objective of the Study

The main objective of the study was to assess the level of experiences of patients following the institution of Kano state government health insurance law in Sheikh Muhammad Jidda General Hospital Kano

1.4.1 Specific Objectives

1. Assess the clients understanding of the cost and operations of KSCHMA.
2. To assess the level of utilization of patient care services at SMTGHK.
3. To assess the level of client’s satisfaction with care services accessibility and level of clients’ care services in SMJGHK
4. To determine the factors that influence the clients’ satisfaction or otherwise of the ongoing KSCHMA
5. To compare clients’ satisfaction with care prior to and after introducing of the scheme