Health insurance in private and public health facilities in Southwestern Nigeria: what determines clients' satisfaction with quality of service?

Introduction: insured-persons have complained about poor quality of services rendered by health care providers, which has consequently affected their satisfaction with care received. The objectives of this study aimed to identify the determinants of satisfaction and compare the level of clients' satisfaction with quality of care received in both public and private health care facilities, in OyoState, Nigeria. Methods: this was a cross sectional study, comparative in design. A total number of 300 clients were recruited from selected public and private health facilities in Oyo-state, using a multistage sampling technique. Data were analyzed using IBM SPSS version 24, and the level of significance was set at p-value < 0.05. Results: the mean age of the respondents in private and public health facilities was 39.9 +/- 10.0 years and 42.4 +/- 10.1 years respectively. About 74% and 41.3% of the enrolees in the public and private health facilities respectively were dissatisfied with waiting time before receiving care with a statically significant difference of p=0.002. Majority of the respondents (82.7%) in the public health facilities and only 42.7% of those using private health care facilities were satisfied with the quality of drugs given to them at their respective pharmacies. This finding was statistically significantly different with p=0.001. Overall level of satisfaction with quality of care was 60% and 40% among enrolees using public and private health facilities respectively. There was a statistically significance difference (p=0.028) between the overall level of satisfaction and the type of health facility used by the clients. The determinants of clients' satisfaction with quality of care in both private and public health facilities in this study were mainly socio-demographic characteristics; age (p=0.007), level of education (p=0.046) and occupation (p=0.004), the waiting time experience and the type of facility where services were accessed. Conclusion: clients attending public health facilities were more satisfied with care received under NHIS, compared with those using private health facilities. Efforts should be made to reduce waiting time and improve quality of drugs in the public and private facilities respectively.