Assessing Health Insurance (NHIMA) coverage of retired patients and their access to health care at Levy Mwanawasa Hospital

Abstract

In Zambia access to healthcare among retirees remains a major concern particularly regarding enrolment and utilization of the NHIS, despite the number growth limited empirical data exists on how retired individuals navigate through healthcare services at Levy Mwanawasa Hospital. In Zambia this transition poses additional challenges as retirees often struggle to have access to health services, although this scheme was introduced to promote equitable and affordable healthcare for all Zambian citizens. Despite a growing number of retirees joining NHIMA, empirical evidence remains limited regarding how patients navigate healthcare under this system, particularly with high volume public hospitals such as Levy Teaching Mwanawasa Hospital. This study adopted a qualitative method was used as an explorative and descriptive design to gain in depth insight into the lived experiences of retired patients aged 60 and above. Data was collected through interviews with purposively selected participants. Data was collected through interviews with purposively selected participants. The thematic analysis was used to analyze the data, well-structured questionnaires were administered to individuals that were willing to participate and express their perceptions, challenges and expectations in details, thematic analysis was also used to analyze the data that was collected. This study revealed a widespread of gaps in health insurance literacy among retirees, with many unsure about how NHIMA operates or how to access its benefits. Low literacy levels proved to be high and often resulted in confusion, delays and underutilization of services available. Additionally, retirees highlighted persistent systematic barriers which included drug stockouts, long waiting hours, perceived negative attitudes among healthcare workers and inconsistent communication. Although some patients acknowledged improvements in financial access due to the health insurance coverage. The Ministry of Health should allocate adequate funding to NHIMA-accredited facilities to prevent drug shortages and ensure timely procurement of essential commodities. The Ministry of Health should strengthen health insurance education for adults, both at community level and also during hospital visits. Furthermore, staff training on customer care and customer service health insurance processes in order to reduce misinformation by Strengthening, accountability mechanisms which will help address the necessary gaps and support progress towards universal health coverage.