A COMPARATIVE STUDY OF FUNDING PATTERN AND QUALITY OF CARE BEFORE AND AFTER INTRODUCTION OF NATIONAL HEALTH INSURANCE SCHEME IN HEALTH FACILITIES

(A CASE STUDY OF ZARIA KADUNA STATE)

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Author

Presented To

Department of Medicine

ABSTRACT
This study was undertaken to assess the trends in funding and the effects of introduction of NHIS on quality of care in health facilities in Zaria, Kaduna State. Methodology: The study was cross sectional descriptive and comparative in design. Using stratified sampling one public and two private health facilities were selected from a total of 9 (7 private and 2 public) secondary facilities accredited by NHIS in Zaria. Information was collected from records on the pattern of funding before and after introduction of NHIS in these facilities. Retrospective analysis of 320 case notes of female patients that were managed in these facilities for maternal complications, 160 case notes a year before (2005) and 160 case notes five years after (2011) introduction of NHIS, was undertaken to compare level of adherence to FMOH Performance Standards for EONC in Nigerian Hospitals as proxy of quality of care. Results: Results of the study demonstrated an almost a 3 -fold increase in financial resource availability in the health facilities reviewed following enrolment into NHIS, with the private facilities having a higher increase(300%) than the publicly owned facility (261%). Funds from the scheme, now constituting up to 36% of the total revenue, accounted for almost half (47%) of the increase. There was also a consequent improvement in physical infrastructure, staff strength and diagnostic capability, though analyses of the aggregate data showed that the differences so observed were not statistically significant. The results showed that quality xx of care, represented by levels of adherence to standard treatment guidelines, was generally poor (42.12%), but a significant improvement in facilities' level of adherence (p= 0.001) was observed following introduction of NHIS, with the public facility performing better (59%) than the private- for- profit facilities (30%), p= 0.005. Conclusion: The study demonstrated improvement in financial resource availability and quality of care following introduction of NHIS in the facilities. Performance based fund imbursement mechanism, cutting administrative cost and specific measures to promote adherence to standard treatment protocols, as a potent quality assurance tool, are recommended.