Factors influencing the use of health insurance in Uganda

Abstract

Over the past two decades, the World Health Organization (WHO) has been pushing for universal health coverage (UHC) globally. This move is aimed at enabling people to access the needed health services without suffering financial hardship by having to incur out of pocket expenses which not only limit access to health care services but also push families into impoverishment. Like other Sub-Saharan countries, the most common way of accessing health services in Uganda is to pay for the costs out of pocket at the point of service. Health insurance coverage in Uganda remains low, standing at 4 percent according to the latest 2019/20 Uganda National Household Survey. The study objectives were twofold: (i) To explore how socio-demographic factors influence health insurance coverage in Uganda; (ii) To investigate the relationship between health- related factors and health insurance coverage in Uganda. This study adopted a cross-sectional design since it was based on data that was collected from a national wide cross-sectional survey, the 2019/20 Uganda National Household Survey (UNHS). This study mainly used data from the socio-economic module which covered all household characteristics including section 5 which covered health insurance. The independent variables were assessed for multicollinearity using variance inflation factor before including them in the model. The study employed logistic regression analysis because the dependent variable was binary. The study notably utilized the Penalized Maximum Likelihood Estimation to ensure unbiased logit coefficients because health insurance coverage was below 5 percent (a rare event). The model was assessed for goodness of fit to the data. Majority of the study participants were female (53.8 percent). Nearly three-quarters (74.3 percent) of all the participants were from rural areas. The average age of the participants was 35 years while the average household size was 6 members. Only 3.5 percent of the participants were covered by any form of health insurance, although most of the participants (39 percent) reported that they would consider joining a health insurance scheme. The variables that significantly influenced health insurance coverage include: residence, marital status, health insurance awareness, and wealth status. Other variables: region, age, household Xi size, and having a chronic disease were not significantly associated with health insurance coverage. Health insurance coverage is still low in Uganda, estimated at 3.5 percent. Residence, marital status, health insurance awareness, and wealth status significantly influence health insurance coverage. There is need to promote health insurance awareness campaigns not only for urban but also rural population to increase health insurance coverage. Government and development partners should continue to support programmes to improve household incomes since wealth status is vital for increased uptake of health insurance in Uganda