Factors Influencing Utilization of Health Insurance in a Tertiary Hospital in Southeast Nigeria

Aims: Sixteen years after the formal sector social health insurance program (FSSHIP) was introduced for the federal civil service in Nigeria. However, there is the paucity of information on how this has affected the level of utilization and satisfaction of the enrollees in Southeast Nigeria.

To evaluate the health services utilization among enrollees and their satisfaction with the scheme.

Methods: Data were analyzed using SPSS version 25. Descriptive statistics-logit models were used to investigate the factors influencing the satisfaction and utilization of health insurance in a tertiary hospital.

Results: The mean age of respondents was 34.0±13.4 years. The program improved the utilization of health insurance services for 60.0% of respondents. However, they have low satisfaction at 36.6% with health service delivery. Factors responsible were long waiting time (80.6%), and payment of extra cost (61.0%), with 36.0% having catastrophic health expenditure. The chi-square value of 29.3, p = 0.02, df = 4 showed a significant association between these variables and poor utilization. Logistic regression showed, females and the married, were more likely to use health services (AOR 2.21, p = 0.02, 95% CI 1.03-2.17 and AOR 4.18, p=0.02, 95% CI; 0.11- 4.60 respectively).

Conclusion: FSSHIP had some positive effects in increasing the utilization of health care. However, the low level of satisfaction in the scheme is a cause for attention for both the HMO’s and the NHIS regulators. The variables causing this should be mitigated. The operators can leverage these factors that increase utilization through public enlightenment.