HEALTH INSURANCE AND SERVICE QUALITY: AN ANALYSIS OF NIGERIA’S NATIONAL HEALTH INSURANCE POLICY

Despite the establishment of the National Health Insurance Scheme (NHIS) to improve access to quality health care and reduce out-of-pocket spending, service delivery under the scheme in Nigeria’s North Central region remains suboptimal. States such as Niger and Plateau continue to experience low patient satisfaction, poor drug availability, limited medical personnel, and weak accountability. The study adopted both primary and secondary data, drawing a sample of 400 enrollees from a population of 522,434 across Benue, Kwara, Nasarawa, Niger, and Plateau States. A total of 374 responses were analyzed using SPSS version 21. Findings revealed significant disparities in health system performance across states. Accessibility to care was highest in Benue (60.7%), Kwara (54.4%), and Nasarawa (58.1%), while Niger (24.7%) and Plateau (29.7%) lagged, largely due to infrastructural and logistical constraints. Emergency responsiveness followed a similar trend, with Nasarawa (51.8%), Kwara (49.4%), and Benue (41%) performing better than Niger (22.2%). Professionalism among healthcare providers also varied, with Nasarawa topping at 77.4% and Plateau at a low of 30.8%. Regarding infrastructure, Nasarawa (77.4%), Plateau (72.6%), and Benue (70.5%) were rated higher, while Kwara and Niger fell short. Perceptions of fairness in service distribution and comprehensiveness were strongest in Nasarawa, Benue, and Plateau. The study concluded that states like Nasarawa, Benue, and Kwara performed relatively better, while Niger and Plateau exhibited critical deficiencies. The study recommended that the NHIA, in collaboration with state governments and regulatory bodies, prioritize infrastructure investment, health worker training, community feedback systems, and improved emergency protocols. The NHIA, in conjunction with the Federal Ministry of Health and regulatory bodies such as the National Health Insurance Commission (NHIC), should institutionalize a comprehensive quality monitoring system that includes regular assessments, performance benchmarking, and public reporting of service outcomes.