Extent of Healthcare Provider Adherence to National Health Insurance Scheme (NHIS) Operational Guidelines: The Nigeria Experience

Ikechukwu Vincent Obi, Ijeoma Lewechi Okoronkwo, Emmanuel Chukwunonye Azuike, Kamtoochukwu Maduneme Obi, Ifunanya Rosemary Obi


The main objective of the National health insurance programme is to improve the health status of the populace in Nigerians. The healthcare provider provision of services in the programme has become a source of worry to government and other stakeholders. This study therefore sets out to examine the extent of healthcare provider adherence to NHIS operational guidelines. Design/Methodology: This is a cross-sectional survey using a questionnaire method. Sample size was calculated (demand side) using G-power 3.1 software and (supply side) Cochran formular and the calculated sample sizes were 1435 and 46 respectively. Multistage sampling technique was applied. Variables were analyzed using descriptive and T- test statistics with SPSS version 25. Result: Out of the 1435 enrollees 80% disagreed that providers provide laboratory services. Also, 91% of them disagreed that providers provide prescribed drugs. In contrast, both the enrollee (67%) and providers (69%) agreed that providers are polite while providing services. The Test value was set at 75%. The calculated T value for operational guideline for enrollees was 70.81 (p<0.05) on the opinion of the enrollees on extent of provider provision of services. The calculated T-value for operational guideline for providers was 2.40 (p<0.05) on the opinion of providers on the provision of services. Conclusion: The evidence from this study have identified areas in the service provision to be addressed by policy makers and in contrast showed that both the enrollees and providers agreed overall that the healthcare providers adhere to NHIS operational guideline.

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DOI: https://doi.org/10.5296/jpag.v9i3.15279

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