Demand for health care and private health insurance in Uganda

Abstract

Since the 1990s, the Uganda Government has implemented several reforms in the health sector, such as decentralisation of health service delivery, removal of user fees, and introduction of community-based health insurance to improve access and utilisation of quality healthcare services. Despite these reforms, levels of health care utilisation remain low. Health indicators such as maternal mortality rates remain high at 336 per 100,000 live births, far above the Sustainable Development Goal three and the third National Development Plan targets. This study examined the determinants of demand for health care and health insurance in Uganda. The study used data from the 2019/20 Uganda National Household Survey and the 2016 Uganda Demographic Health Survey. A multinomial logit model, trivariate probit model, and binary logit model were then estimated using Stata. The findings showed that the cost of health care negatively influenced the choice of government health facilities, while household welfare positively influenced the choice of private health facilities. Having a health insurance cover was positively associated with the choice of any health care provider. Duration and type of illness have implications for the health care system through the increased burden and patient’s ability to pay for health care services. The study further found that having a health insurance cover significantly increased the probability of utilising antenatal care and delivery at a health facility by 30% and 28%. Wealth index, post-secondary education, birth order, and region significantly influenced all three maternal health care outcomes. The results also showed that wealth index, education level, age, marital status, region, and access to information were significant determinants of demand for voluntary health insurance in Uganda. The study recommends that the government facilitates and fast-tracks the enactment and implementation of the national health insurance scheme, increases investment in the health sector, and enhances access to health information.