HEALTH INSURANCE IN IMO STATE A COMPREHENSIVE ANALYSIS OF AWARENESS, ATTITUDES, ENROLLMENT CHALLENGES, CARE QUALITY AND FINANCIAL IMPLICATIONS AMONG PATIENTS IN PUBLIC AND PRIVATE HOSPITALS.

ABSTRACT Introduction: Health insurance coverage in Nigeria remains extremely low with significant challenges such as poor awareness, limited geographical focus and socioeconomic barriers particularly in rural areas leading to wide spread reliance on out of pocket health care payments. The outcome of this research seeks to address gaps in existing research while also comparing public and private healthcare sectors to better inform policies for improving healthcare coverage in Nigeria. Objective: To examine the Health Insurance Awareness, Attitudes, Enrollment barriers,Care quality and Financial implication among patients attending Public and Private Hospitals in Imo State. Methodology: This study employs a descriptive cross-sectional design to evaluate the study. The study targets patients from both public and private hospitals using a multistage sampling technique with a calculated sample size of 269 using a semi-structured, interviewer-administered Open Data Kit (ODK) questionnaire covering sociodemographic characteristics, awareness, attitudes, enrollment issues, quality of care, and financial aspects of health insurance. Simple random technique was used to select respondent and data was analyzed using the statistical package for social science (SPSS) version 25.0 and the information obtained was represented using tables. Results: A survey of 269 patients attending public and private health facilities in Imo State revealed the following socio-demographic characteristics: the majority of respondents were aged 18-35 (public: 60.4%, private: 66.7%), married (public: 60.4%, private: 56.3%), and predominantly of Igbo ethnicity (public: 91%, private: 85.9%). Awareness of health insurance was higher among public facility users (74.6%) compared to private facility users (68.9%), with the main sources of information XII being family and friends. However, awareness of specific treatments covered and different insurance packages was generally low. Attitudes toward health insurance were mostly neutral, with a slightly higher positive attitude observed among private facility users. Enrollment in health insurance schemes was low, with 72.86% of respondents not enrolled. Key barriers to enrollment included cost, lack of awareness, and mistrust of insurance providers. Satisfaction with health insurance was also low, with few respondents satisfied with the quality of care, staff responsiveness, wait times, and facility cleanliness under their health insurance schemes. Conclusion: The study reveals significant gaps in Awareness, Enrollment, and Satisfaction with Health Insurance among patients in Imo State. High costs, lack of information, and mistrust of providers are major barrier. Addressing these issues can lead to better health outcomes and wider insurance coverage. Key words: Health insurance ,Awareness, Attitudes, challenges, Imo.