Equity of care: A comparison of National Health Insurance Scheme enrolees and fee-paying patients at a private health facility in Ibadan, Nigeria

This study compared the cost and process of care for patients enrolled in the National Health Insurance Scheme (NHIS) to those who made out-of-pocket payments for health care. A cross-sectional analytical study design was used. Data were obtained from case files of patients. The study was conducted at a privately owned general hospital in the city of Ibadan, Southwest Nigeria. A total of 200 NHIS enrollees and 200 fee-paying patients seen between January and March 2010 were recruited using a systematic sampling technique. Differences in the cost and process of care was determined by comparing cost, diagnostic process, and treatment of common ailments. Associations were explored with the chi square test, mean were compared with t-test. Level of significance was set at 5%. Only 15% of the NHIS enrollees had a diagnostic test done compared with 28.5% of the fee-paying group (P < 0.05). Overall, the mean cost of care was $14.2±5.12 (₦2,135±772) for the NHIS enrollees and $18.6±6.1 (₦2,796±914) for their fee-paying counterparts (P<0.001). This study, indicates that some disparity exists in the cost and processes of care for these two categories of patients. It is important to ensure quality in the services received by the NHIS enrolees.