Effect of the eQuality health Bwindi scheme on utilisation of health services at Bwindi community hospital

Abstract

eQuality Health Bwindi is a Community Based Health Insurance (CBHI) scheme that was initiated to increase access to health care at Bwindi Community Hospital (BCH). This research sought to determine the effect of the scheme on utilisation of BCH services between FYs 2009/10 and 2013/14 among households of Kayonza sub-county. The research findings will be useful for scale up of the scheme and policy formulation in Uganda. Methods and Materials: The study involved: a review of hospital records for the period July 2009 – June 2014, a survey of 272 households, four focus group discussions, and six key informant interviews. Quantitative data was entered into Epidata and analysed using SPSS. Qualitative data was transcribed and analysed by content analysis. Results: There was a 65%, 73% and 27% increase in the outpatient attendance, inpatient admissions and deliveries respectively at BCH between FY 2009/10 and FY 2012/13 after the launch of equality Health Bwindi scheme in March 2010. The proportion of the insured participants that used BCH services for a sick child was greater than the proportion of the non-insured that used BCH services for a sick child, p-value = 0.0038. This was not the case for those that sought BCH services for self. Oopting out of the scheme led to reduced utilisation of BCH services and was attributed to unaffordable premiums and co-payments among some people and limited understanding of the health insurance concept among others. Conclusions: CBHIs have the potential to increase health care utilisation however they are a challenge in situations where there is limited understanding of the concept of health insurance and premium adjustments have to be made to improve health service delivery and management.