ORIGINAL ARTICLES Assessment of Perceived and Objective Quality of Care Received by Insured versus Uninsured Adult Patients Attending a Tertiary Hospital in Nigeria
West Afr J Med . 2023 Jun 29;40(6):646-653.
Keywords:
Health insurance; Insured and uninsured adult patients; Objectivequality of care; Perceived quality of care.Abstract
Abstract in English, FrenchBackground and objectives: Health insurance relieves problems with out-of-pocket payments. It is uncertain whether equal care is received by insured and uninsured patients. We compared objective and perceived healthcare quality between insured and uninsured adults at the study site to make appropriate recommendations that would improve healthcare quality.
Methods: We conducted a comparative cross-sectional study at the General Outpatient Clinic of National Hospital, Abuja, Nigeria from February to May 2020. Using systematic sampling, we recruited 238 insured and uninsured adults and interviewed them with a semi-structured questionnaire and an observational checklist (for perceived and objective quality of care respectively). We used the independent t-test and chi-square test to assess the relationship between health insurance status and socio-demographic characteristics, clinical characteristics and perceived and objective quality of care.
Results: The mean age (±SD) of participants was 42.0 ± 11.6 years with 131 (55.0%) insured respondents. Overall perceived quality of care was higher among the uninsured (P<0.001). There was no significant difference between insured and uninsured patients concerning the comprehensiveness of objective healthcare quality indicators.
Conclusion: We found that the uninsured perceived healthcare quality to be better than the insured, which is unexpected. Since the uninsured patients were fewer in number, paid immediately, and had shorter waiting times, they perceived that: health providers respected them more, drugs were more available to them and consulting rooms and health providers were more sufficient. We recommended that the hospital management should commence regular healthcare quality assessments to improve healthcare quality. This could increase the patients' confidence in the health system.
Keywords: Health insurance; Insured and uninsured adult patients; Objectivequality of care; Perceived quality of care.
