Assessing responsiveness of health care services under private health insurance in Kampala : the client, provider and insurer perspective

Abstract

Introduction: Globally, many countries prioritize addressing responsiveness of health systems as a key indicator of health system performance (WHO, 2015). The catastrophic Out-of-pocket (OOP) expenditure on health care of up to 40% of Uganda’s total health expenditure (MoH, 2018) partly informed the adoption of other financing mechanisms such as private health insurance (PHI) to remedy this situation. With high expectations of accessing quality health care, about 7 % of employers in Kampala are supporting close to 4% of their employees under PHI (UBOS, 2020b), we do not know the different factors that shape the relationships between the clients, providers and insurers plus how their respective expectations are met. Objective: This study aimed to assess responsiveness under private health insurance in Kampala focusing on the client, provider, and insurer perspective. Methodology: This case study employed qualitative data collection methods. A total of 10 Focus group discussions with insured clients and 9 Key Informant Interviews with insurer and provider focal point persons were conducted. We assessed expectations on some modified non-medical aspects according to the WHO domains for the insured clients. Provider and Insurer’s factors like payment mechanisms, service eligibility and timeliness of payment were also studied. Data was thematically analyzed using Atlas ti, Version 6 software and presented using anonymized narratives and quotes. Findings: Client-Provider, Client-Insurer and Provider-Insurer expectations were generally not met. Client-Provider expectations; Although most facilities were clean with a conducive care environment, clients experienced long waiting time, and inadequate feedback about their services while prompt care was received by a few. Also, Client-insurer expectations; under unclear service packages, clients ended up receiving low-quality medicines. Regarding Provider-insurer expectations; delayed payments, selective periodic assessments, and inadequate orientation of clients on insurance plans were reported. Weak coordination links did not support delivery processes for quality service. Conclusion: Health care service responsiveness was generally low. Noted performance limitations require intentional strategic investment of resources. This will support setting up clearer service package orientation programs and robust monitoring and feedback platform. The proposed National Health Insurance Act may use these findings to inform its design improvement initiatives such as operating under realistic expectations, investment in quality improvement systems and customer care relationship while using well calibrated accountability tools.