Assessing Determinants of Enrollees' Satisfaction with Quality of Health Services within the State Social Health Insurance Scheme: An Application of Modified SERVQUAL Model.

Background: Patient satisfaction is an important indicator to measure the quality of healthcare and provider performance. Understanding enrollees' satisfaction with the quality of health services provided by Anambra State Health Insurance Scheme is crucial for its effectiveness.

Aim: This study assessed health insurance enrollees' satisfaction with the quality of care and its determinants in Anambra State, Nigeria.

Methods: This was a cross-sectional study that involved 447 enrollees selected from health facilities using a multistage sampling technique. Data was collected using a 25-item structured close-ended patients' satisfaction questionnaire adapted from the SERVQUAL model. Data analysis was done using SPSS version 25. Logistics regression analysis was done to identify determinants of overall satisfaction. The level of significance was set at a P value <0.05.

Results: The overall level of satisfaction with services rendered was 80.6%. Enrollees were satisfied with tangibility (87.2%), reliability (89.3%), responsiveness (80.3%), assurance (90.2%), empathy (87.5%), and affordability (81.4%). Significant factors associated with the enrollees' satisfaction across the six dimensions of care assessed were facility ownership (AOR = 1.42; CI 0.24-0.74; P < 0.00) and geographical location (AOR = 1.33; CI 0.14-0.78; P < 0.01). Age (AOR = 2.86; CI 1.55-5.29; P < 0.00) was the only demographic characteristic associated with satisfaction with care.

Conclusion: The quality of care was satisfactory across dimensions of care assessed. However, enrollees' satisfaction was positively influenced by facility-related factors. Managers and healthcare providers should focus on continuous quality improvement efforts in public and rural facilities to improve the quality of services and enrollees' retention within the health insurance scheme.