ABSTRACT
One major component of access to healthcare is utilization of healthcare services. The National Health Insurance Scheme (NHIS) was designed to reduce the impact of poverty on the ability of the enrollee to utilize healthcare services. The question is has NHIS increased the utilization of health care services and offered financial protection to its beneficiaries? The purpose of this study is to analyze comparatively, the healthcare cost and utilization of healthcare services by the insured and uninsured federal civil servants in Abakaliki Ebonyi State. A comparative descriptive cross-sectional design was used for the study. The sample size was 216. A multistage sampling procedure was employed to draw respondents for the study. The instrument for data collection was a researcher developed questionnaire. A total of 186 copies of the administered questionnaire were analyzed. About 84.7% of the NHIS insured and 98.4% uninsured federal civil servants had poor utilization of healthcare services. The un-insured paid more out of pocket on medicine and diagnostics (1000-5000), than insured federal civil servants (600-3000). The insured had good satisfaction with healthcare services [mean 2.7(±0.5)] while the un-insured had poor satisfaction with Healthcare services [mean 1.7(0.4). There was no significant difference in Healthcare utilization between the insured and the un-insured (p > 0.05) despite a significant difference in early visit to hospital (access to Healthcare) (p < 0.05). There was a significant difference in Healthcare cost between the insured and the un-insured (p < 0.05). There was significant difference in satisfaction with Healthcare services between the insured and the un-insured (p < 0.05). The study concluded that NHIS offered financial protection to its beneficiaries. It was recommended that a well structured federal civil service employment process be instituted such that enrollment into the NHIS would be part of the statutory requirements for employment into the Federal Civil Service and public enlightenment programmes on the operations of the NHIS be intensified.
TABLE OF CONTENT
Title page i
Approval page ii
Certification page iii
Table of content iv
List of tables v
Abstract vi
Introduction
Background of the study 1
Statement of problem 4
Purpose of the study 5
Objectives of the study 5
Research hypotheses 5
Significance of the study 6
Scope of the study 7
Operational definition of terms 7
Literature review
Conceptual review 9
Concept of utilization of healthcare services 9
Concept of healthcare cost 10
Concept of health insurance 11
National Health Insurance Scheme in Nigeria 16
Insurance and Healthcare Utilization 18
Insurance and Healthcare Cost 19
Satisfaction with Healthcare 20
Theoretical review 21
Empirical review 24
5
Summary of literature review 30
Research methods
Research design 31
Area of study 31
Population of study 32
Sample 32
Sampling procedure 33
Instrument of data collection 33
Validity of instrument 34
Reliability 34
Ethical consideration 34
Procedure for data collection 35
Method of data analysis 35
Presentation of results 36
Discussion of findings 47
Limitation of the study 51
Implications of the findings 52
Summary of Study 53
Conclusion 53
Recommendation 54
Suggestions for further study 55
References 56
Appendix i (Questionnaire)
Appendix ii (Pilot test result)
Appendix iii (ethical clearance)
