Factors Influencing the Choice of Healthcare Providers among National Health Insurance Scheme Enrollees in Public and Private Health Facilities in South Western Nigeria: A Mixed Method Study

Abstract

Objectives: The choice of healthcare facilities is determined by the interaction of several factors and the perceived quality of care provided in the facilities. This study aimed to assess the factors influencing the choice of service providers among NHIS enrollees in public and private health facilities in Southwestern Nigeria. Methods: A cross-sectional and mixed-method study design using both qualitative and quantitative data collection methods. Using a multistage sampling technique, 300 patients were enrolled. Four focus groups with eligible respondents were conducted in public and private health facilities. IBM SPSS was used to analyze the data, and a p-value of less than 0.05 was designated as the significance level. Qualitative data were collated and analyzed using detailed content analysis. Results: The study found that 50 (33.3%) public and 37 (24.7%) private health facilities respondents had ever changed their health care providers respectively, but this was not statistically significant (p=0.098). Determinants of choice of healthcare providers among the public and private health facilities enrollees include; use of facility before joining the scheme (p<0.001), courteous/friendly hospital staff (p=0.042), adequate personnel and equipment (p=0.002), skills and expertise of personnel (p=0.03), use of health facility by majority of colleagues, (p<0.001) and spending greater than 10 years in the scheme (p=0.007). Conclusion: Factors influencing the choice of healthcare providers among respondents in public and private health facilities, were mainly health facility related. Accredited healthcare providers seeking to improve the enrollment of new clients as well as retain their old clients should address these factors.