Evaluating Quality of Care Under Nigeria's National Health Insurance Scheme: A Thematic Analysis of Patient Narratives at a Tertiary Care Public Hospital

Objective: Patient narratives provide in-depth insights of user quality ratings of healthcare delivery but are underutilized. The assessment of patient satisfaction often relies on survey data based on quantifiable indicators. While quantifiable indicators provide a snapshot of patient perceptions of the care they receive, they tend to gloss over pertinent details to understand their experiences and perceptions of the quality of care they received. This study assessed patients' narratives to better understand patient satisfaction ratings of healthcare services provided under the National Health Insurance Scheme (NHIS) in Nigeria. Method: A cross-sectional survey using semi-structured interviews of 406 participants was conducted in a Nigeria tertiary hospital. Quantitative data was collected on participants' sociodemographic characteristics and core domains of patient satisfaction. Qualitative data was collected from 279 participants' responses to open-ended questions on their perceptions and experiences and assessed using thematic analysis. Results: Overall patient satisfaction rate was 47.5%. Five key themes were identified: i) medicine unavailability and poor quality, ii) authorization code approval delays, iii) lack of human resources and soft skills, iv) high out-of-pocket expenditure and v) scheme complexity and ineffectiveness. Conclusions: Study findings highlight patient frustrations with accessing healthcare which are compounded by systemic issues under the NHIS. These findings highlight the need for health policy interventions to improve service delivery and enhance overall system efficiency under the NHIS.