Awareness, knowledge and perceptions of physicians of the National Health Insurance Scheme in Nigeria: An exploratory study

Abstract

Nigeria implemented a National Health Insurance Scheme (NHIS) in 2005, introducing monumental changes to the health care delivery system. This study assessed physicians’ understanding of the objectives of the NHIS as well as their perceptions of the scheme, to identify their level of acceptance and support of the health policy reform. A convenient sample of 134 physicians residing in South-East Nigeria were surveyed via a self-administered questionnaire. Descriptive statistics were used to summarize study data. Aggregate knowledge scores regarding health insurance and the NHIS objectives were assessed. Measures of consensus (Cns) of physicians’ perceptions of the health reform were also obtained. Study results show a high level of awareness and support for the NHIS among participants. However, there were deviations between awareness of the NHIS and knowledge of the program’s objectives. Aggregate knowledge scores differed significantly by age group, length of years of practice, place of employment and location. Further, consensus measures of physician’s perceptions of NHIS (Cns index = 0.69) and the introduction of Health Maintenance Organizations (HMOs) as intermediary operators of the scheme (Cns index = 0.68) were positive and considered strong while perceptions on associations between HMOs and corruption in the country was moderate (Cns index = 0.56) and slightly negative. This study demonstrates physicians’ support for the NHIS program in Nigeria and an acceptance of changes implemented with the health policy reform. Knowledge gaps were identified, highlighting the need for increased awareness of the reform and its objectives.