Utilization of health insurance by patients with diabetes or hypertension in urban hospitals in Mbarara, Uganda

Abstract

Background: Diabetes and hypertension are among the leading contributors to global mortality and require life-long medical care. However, many patients cannot access quality healthcare due to high out-of-pocket expenditures, thus health insurance would help provide relief. This paper examines factors associated with utilisation of health insurance by patients with diabetes or hypertension at two urban hospitals in Mbarara, southwestern Uganda. Methods: We used a cross-sectional survey design to collect data from patients with diabetes or hypertension attending two hospitals located in Mbarara. Logistic regression models were used to examine associations between demographic factors, socio-economic factors and awareness of scheme existence and health insurance utilisation. Results: We enrolled 370 participants, 235 (63.5%) females and 135 (36.5%) males, with diabetes or hypertension. Patients who were not members of a microfinance scheme were 76% less likely to enrol in a health insurance scheme (OR = 0.34, 95% CI: 0.15 – 0.78, p = 0.011). Patients diagnosed with diabetes/hypertension 5 – 9 years ago were more likely to enrol in a health insurance scheme (OR = 2.99, 95% CI: 1.14 – 7.87, p = 0.026) compared to those diagnosed 0 – 4 years ago. Patients who were not aware of the existing schemes in their areas were 99% less likely to take up health insurance (OR = 0.01, 95% CI: 0.0 – 0.02, p < 0.001) compared to those who knew about health insurance schemes operating in the study area. Majority of respondents expressed willingness to join the proposed national health insurance scheme although concerns were raised about high premiums and misuse of funds which may negatively impact decisions to enrol. Conclusion: Belonging to a microfinance scheme positively influences enrolment by patients with diabetes or hypertension in a health insurance program. Although a small proportion is currently enrolled in health insurance, the vast majority expressed willingness to enrol in the proposed national health insurance scheme. Microfinance schemes could be used as an entry point for health insurance programs for patients in these settings. Key words: Health insurance, universal health coverage, diabetes, hypertension, Uganda