Health Insurance Status and Quality of Care: Comparative Evaluation of Insured and Uninsured Diabetic Patients in a Tertiary Healthcare Facility in North Central, Nigeria

Abstract

Background: Patients’ satisfaction is increasingly gaining global acceptance as one of the main tools for the assessment of the quality of healthcare delivery. Despite efforts to ensure equitable quality of care for all diabetic patients, a significant gap persists between the quality of care experienced by insured diabetic and uninsured diabetic patients. This study assessed patient satisfaction with services provided, and findings are useful in healthcare policy formulation and quality improvements. Materials and Methods: A descriptive cross-sectional study was done to evaluate satisfaction with the quality of care among insured diabetic patients and uninsured diabetic patients at Medical Outpatient clinics of UITH, Ilorin, Nigeria between 1st May to 31st July 2023. Data were collected from 144 patients selected by systematic random sampling; using pretested, structured, interviewer-administered questionnaires with each satisfaction area scored in a five-point Likert scale ordinal response. The questionnaire contained information on socio-demographic characteristics and accessed services. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 27.0 software (SPSS Inc., Chicago, IL, USA). Results: The overall mean satisfaction of the uninsured group (68.3 ± 16.0) was slightly higher than that of the insured group (65.7 ± 15.2). This was not statistically significant with p value = 0.081. However, the uninsured group had better satisfaction scores in the domains of hospital environment (71.44 ± 16.1 vs 64.7 ± 19.7), quality of prescribed drugs (79.8 ± 16.6 vs 62.5 ± 7.3) and drug availability (76.0 ± 15.9 vs 59.8 ± 18.8), these were statistically significant with p values of 0.029, <0.001 & <0.001 respectively. On the other hand, the insured group had better satisfaction scores in the domains of drug cost and affordability (70.8 ± 14.2 vs 63.7 ± 16.2) and cost of service and care (74.4 ± vs 66.4 ± 14.4). The differences were statistically significant with p values of 0.006 and 0.001 respectively Conclusion: Significant differences were noted in specific areas of service assessed with the uninsured having higher satisfaction with hospital environment, availability and quality of drug, while the insured were more satisfied with the affordability of drug and cost of service.