Evaluating access to National Health Insurance Scheme Services

Abstract

Access to health insurance is vital for achieving Universal Health Coverage, yet barriers such as high costs, inadequate coverage, and systemic inefficiencies often impede access to necessary health care. This study evaluated access to the National Health Insurance Scheme-provided services among enrollees at the outpatient department (OPD) of Levy Mwanawasa University Teaching Hospital (LMUTH) in Lusaka, Zambia, chosen for its role as a pioneering NHIS-accredited facility and its significance as a major publicly funded referral hospital. Data were collected in May 2024 from 270 systematically sampled NHIS enrollees at the OPD of LMUTH using an interviewer-administered questionnaire. Descriptive analysis revealed a balanced gender distribution, with most respondents aged 35 and above, married, holding tertiary education, and earning a monthly Zambian Kwacha (ZMW) of 20,000 or less. The thematic analysis using NVivo uncovered positive and negative experiences with NHIS services, highlighting issues such as medical service availability, drug shortages, service delays, technological problems, communication challenges, equity in service delivery, and coverage gaps. The key policy implications for improving access to NHIS services include enhancing supply chains, digital infrastructure, coverage to rural areas, staff training, public awareness of the NHIS, and information technology systems.

Keywords: {'name': 'national health insurance scheme'}, {'name': 'thematic analysis'}, {'name': 'accessibility'}, {'name': 'affordability'}

Authors & affiliations

Wesley Mwambazi
Affiliation not supplied

Mubanga Mpundu
Affiliation not supplied

Deposited references

Supplied references, not a list of publications citing this article.

DOI: 10.18502/ijph.v52i7.13236

DOI: 10.1186/s12913-021-07144-2

DOI: 10.1186/s12875-021-01394-z

Araoye, M. A. (2003). Sample Size Determination. In Research Methodology with Statistics for Health and Social Sciences (1st ed., pp. 115-121). Nathadex Publishers.

DOI: 10.1186/s13561-019-0255-5

DOI: 10.1186/s12961-019-0493-3

Chowdhury, J., & Ravi, R. P. (2022). Healthcare Accessibility in Developing Countries: A Global Healthcare Challenge. Journal of Clinical & Biomedical Research, 4(152), 2-5. https://doi.org/10.47363/JCBR/2022.SRC/JCBR-164

DOI: 10.4337/jqrt.2023.0006

DOI: 10.1007/s40258-014-0148-z

DOI: 10.1111/tmi.13651

DOI: 10.3389/fpubh.2021.714127

DOI: 10.1371/journal.pgph.0003538

DOI: 10.1111/jan.15688

DOI: 10.1057/gpp.2008.6

Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. (1993). Access to health care in America (M. Millman, Ed.). Washington, DC: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK235882/

DOI: 10.24083/apjhm.v18i1.1689

DOI: 10.1016/j.ssaho.2023.100399

DOI: 10.1007/s10120-016-0597-1

DOI: 10.1177/0021909619827331

DOI: 10.1186/s12939-014-0130-2

DOI: 10.1186/1475-9276-12-18

DOI: 10.1177/21501319231153593

DOI: 10.1596/31786

DOI: 10.1016/j.hpopen.2020.100020

DOI: 10.1111/1475-6773.12171

DOI: 10.1186/s12939-021-01416-3

Ministry of Health. (2023). 2022-2026 National Health Strategic Plan. Retrieved from: www.moh.gov.zm/wp-content/uploads/2023/02/National-Health-Stratergic-Plan-for-Zambia-2022-to-2026-revised-February-2023-lower-resolution.pdf

DOI: 10.1186/s12942-023-00338-3

DOI: 10.4324/9781315517971-21

DOI: 10.1186/1475-9276-12-9

DOI: 10.1007/s10389-024-02207-0

DOI: 10.1080/01488376.2023.2265417

DOI: 10.1186/s12913-018-3249-9

DOI: 10.1196/annals.1425.011

DOI: 10.1177/1355819615600001

DOI: 10.1371/journal.pone.0268940

DOI: 10.1186/s12913-024-10827-1

DOI: 10.1002/hec.1492

World Health Organization. (2010). World health statistics 2010. World Health Organization. Retrieved from: http://www.who.int/docs/default-source/gho-documents/world-health-statistic-reports/en-whs10-full.pdf

DOI: 10.1186/s12939-015-0240-5