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)