Satisfaction and compliance with compulsory health insurance in Bamako District Hospital IV, 2023

Abstract

Introduction : Health insurance is an area of social security responsible for providing an individual with all or part of the cost of care in the event of illness, and a minimum income in the event of sick leave. The aim of the study was to investigate the satisfaction and compliance of members of the compulsory health insurance (AMO), in order to contribute to the effectiveness of the insurance system in improving the quality of health insurance services. Material and Methods: This was a cross-sectional study conducted in the district hospital of Bamako's commune IV between August 2021 and January 2022. We used simple random sampling by estimating the size with the Schwartz formula, which was 100 members. All AMO members or their beneficiaries over 16 years of age who agreed to participate in the study were included. Data were collected through face-to-face interviews. Data were analyzed using SPSS 21 software. Free and informed consent was obtained from participants prior to enrollment. Anonymity and confidentiality were maintained. Results: The satisfaction rate was 95%, justified by the availability of affordable drugs according to 89% of the participants. For those who were dissatisfied, the main reasons were complexity of procedures, long waiting times, and poor reception by staff. Members had committed fraud in 19% of cases, mainly in collusion with a health worker or an AMO agent. Conclusion: An effective communication method is needed to address barriers to health care access in order to improve member satisfaction and reduce fraud.