Knowledge and Practice of the Referral System under the National Health Insurance Scheme among Medical and Dental Practitioners of A Large-Accredited Facility in Kano, Nigeria

G. C. Michael, A. U. Gajida, B. A. Grema, I. S. Abubakar, I. Aliyu, K. U. Omeje, I. M. Inuwa, A. Ajiya, M. S. Kurawa, M. A. Ramalan, S. T. Tanimu, A. K. Suleiman

Abstract

BACKGROUND: Studies on healthcare professionals' knowledge
about the National Health Insurance Scheme (NHIS) are scarce.
Therefore, we assessed the knowledge and practice of the NHIS referral
system among Medical and Dental practitioners in a tertiary hospital in
Northwest Nigeria.

METHODS: This cross-sectional study involved 242 medical and
dental practitioners randomly selected from nine departments for over 6-
weeks. A structured self-administered questionnaire was used to collect
data. Data were analyzed using descriptive and inferential statistics.

RESULTS: The respondents' mean age was 35.7±6.0 years; they were
predominantly males (64.9%). Their mean overall knowledge score was
58.9±23.0%, with 66.9% of respondents having inadequate overall
knowledge of the NHIS referral system. Practice department (Fishers
exact, P=0.0019), perceived knowledge of the referral system (ꭓ2 =8.169,
P=0.004), and having been referred as an enrolee (ꭓ2 = 6.358, P=0.012)
were associated with overall-knowledge. Obstetrics-and-Gynaecology
(odds ratio[OR]=0.29, 95% confident interval [CI] [0.88-0.98]), Dentaland-
Maxillofacial-Surgery (OR=0.08, 95%CI[0.01-0.98]), and
Otorhinolaryngology (OR=0.18, 95%CI[0.04-0.80]) respondents were
less likely to have adequate overall-knowledge. Although 56.2%, 50.4%,
20.7%, and 89.7% were enrolees, had received treatment as enrolees, had
been referred as enrolees and treated other enrolees, respectively, an
unimpressive proportion had sighted a referral letter (64.9%) or
authorization code on the letter (25.2%), referred an enrolee from their
department previously (51.2%) or used the NHIS referral form to write
referrals (38.8%).

CONCLUSION: The overall knowledge of the NHIS referral system
was inadequate. The practice of the referral system was below
expectation. Therefore, training medical and dental practitioners on the
NHIS referral system is necessary. Training should target those who are
least likely to have adequate overall knowledge.

KEYWORDS: Knowledge and Practice, Medical Practitioners,
National Health Insurance Scheme, Nigeria, Referral