Waiting Time, Patient Satisfaction and Continued Use of NHIS Healthcare Services Among Enrollees in a Nigerian Tertiary Hospital: A Convergent Mixed-Methods Study
This convergent mixed-methods study of 376 survey respondents and 20 interviewees at a Nigerian tertiary hospital reveals that while prolonged waiting times significantly reduce patient satisfaction, the majority of NHIA enrollees remain satisfied with and willing to continue using the scheme due to its affordability and access to care, suggesting that operational improvements in authorization and queue management could further enhance retention.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many parts of the world, having health insurance is meant to be a shield against financial ruin and a ticket to timely medical care. The idea is simple: by paying into a shared pool, individuals can access doctors and medicines without the fear of being bankrupted by a sudden illness. In Nigeria, the National Health Insurance Authority manages this system, aiming to ensure that citizens can get the care they need without suffering severe financial hardship. However, having a ticket to the show does not guarantee a good seat or a smooth entry. For any insurance scheme to truly work, the experience of using it must match the promise it makes. If the process of getting treated is slow, confusing, or frustrating, people may lose faith in the system, even if the medical care itself is good. This tension between the promise of coverage and the reality of the wait is at the heart of understanding whether people will keep using their insurance or drop it when things get difficult.
A team of researchers set out to understand exactly how this plays out for patients in southeastern Nigeria. They focused on a large teaching hospital in Abakaliki, a place where many people go for specialized care. The researchers wanted to know three things: how long people actually waited to see a doctor, whether they were happy with the service they received, and if they planned to keep using the insurance scheme in the future. To get a full picture, they did not just ask people to fill out a form; they also sat down and listened to their stories. They spoke with nearly 400 patients who had just finished their visits and conducted deeper conversations with twenty of them to understand the feelings behind the numbers.
The results painted a picture of a system that is struggling with time, even while holding onto the loyalty of its users. More than half of the patients surveyed had to wait at least three hours before they were seen by a healthcare provider. Nearly one-third of them waited four hours or longer. When asked to rate this wait, most people were not kind; about 58 percent described the waiting time as poor or very poor. The delays were not just about sitting in a chair. Patients described a process filled with administrative hurdles, such as waiting for codes to be generated to authorize treatment, dealing with doctors who arrived late, and watching others seemingly jump the queue. One patient described spending an entire day in the hospital just to get the paperwork sorted before treatment could begin.
Despite these long and frustrating waits, a surprising number of patients remained satisfied with the care they received. About 62 percent said they were satisfied or very satisfied with the healthcare services. Even more striking, 83 percent said they were willing to continue using the insurance scheme. This seems contradictory at first glance: why would people be happy and willing to stay in a system that makes them wait so long? The researchers found that the answer lies in what the insurance actually provides. For many, the financial protection was the deciding factor. Patients noted that the scheme paid for most of their bills, making expensive treatments and specialist care affordable for their families. They also felt that the medicines they received worked and that they were recovering well. The value of not having to pay out of pocket was strong enough to outweigh the stress of the wait for most people.
However, the wait was not just a minor inconvenience; it was a significant barrier that shaped how patients felt about the entire experience. The study found a clear link between how long someone waited and how satisfied they felt. Those who perceived the wait as long were less likely to be happy with the service. Furthermore, satisfaction was the key driver for whether someone wanted to stay in the program. People who felt satisfied with their overall experience were much more likely to say they would keep using the insurance. The researchers explained that while the money saved kept people in the system, the quality of the experience determined how long they would stay. When the delays became too stressful or the administrative processes felt unfair, even the financial benefits began to feel less valuable.
The study also highlighted specific problems that made the waiting time worse. It was not just that there were many patients; it was that the system itself created bottlenecks. The process of generating treatment codes, which is required to access care, was often slow and confusing. Patients felt that the lack of punctuality from some providers and the perception that some people were allowed to cut in line added to the frustration. These issues made the wait feel like a waste of time rather than a necessary part of getting better. When patients had to wait all day only to find that their prescribed drugs were out of stock, the value of the insurance seemed incomplete.
The researchers concluded that while the insurance scheme is doing its job of protecting people from financial ruin, the way care is delivered needs to improve to keep people confident in the system. The study suggests that if hospitals can streamline their administrative processes, manage their queues more fairly, and ensure that doctors and medicines are available when promised, patient satisfaction will likely rise. This, in turn, would strengthen the willingness of people to continue using the scheme. The findings show that health insurance is not just about money; it is about the entire journey of getting care. If that journey is too long and too difficult, even the best financial protection may not be enough to keep people coming back. The study serves as a reminder that for a health system to truly succeed, it must be efficient and respectful, not just affordable.
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