Effect of individual contributions to private health insurance premium on medical service utilization in Uganda

Abstract

Introduction Sustainable health financing is a fundamental goal for every health system. Other than accessible financing, efficiency and minimization of waste are important factors in building a sustainable healthcare system. Medical service utilization is an important healthcare cost driver, this study investigated medical service utilization difference and associated factors between contributor and non-contributor health insurance schemes Materials and methods The study used secondary data 1st of July 2021 to 31st June 2022. from a private health insurance company in Uganda, the general characteristics of the study population were investigated using t-tests and analysis of variance (ANOVA). Linear regression analysis based on the generalized estimating equation (GEE) model, was used to study the relationship between Medical insurance premium contribution status and medical service utilization (number of outpatient visits and inpatient visits) Results Data from 31,308 participants were analyzed, 7.4% were in the contributor scheme, while 92.6% were in the non-contributor scheme. The average number of outpatient visits was 5.50 (SD 4.93) compared to 4.86 (SD 4.42) vs 5.55 (SD 4.86) in the contributor scheme and non-contributor schemes respectively. The average inpatient admissions per person were 0.12 (SD 0.4), with the contributor scheme at 0.08 (SD 0.33) and non-contributor’s scheme at 0.12 (SD 0.42). Participants with chronic conditions had 8.4 outpatient visits, compared to 5.39 for those participants without chronic condition. Participants with chronic conditions had slightly higher average outpatient costs in the non-contributor scheme (contributor scheme UGX 99,639 (SD 84,830) vs non-contributor scheme UGX 103,222 (SD 100,258)). The average cost of an inpatient visit was slightly lower in the non-contributor scheme (contributor UGX 1,440,000 (SD 1,500,000) vs non-contributor scheme UGX 1,310,000 (SD 1,960,000)) in the absence of a chronic condition, the presence of a chronic condition reversed the trend with the outpatient cost in the non-contributor scheme slightly less (UGX 1,550,000 SD 2,230,000 vs non-contributor scheme UGX 2,290,000 (SD 3,750,000)). The number of outpatient visits per person in the non-contributor scheme was twice (P<0.000) that of the contributor scheme. The average number of inpatient visits per person was similar in both schemes. Males were less likely to attend outpatient visits compared to females (RR 0.7 CI 0.634-0.790). There was an increasing risk of attending outpatient services with increasing age, with participants above 50 years having 2.6 times (p<0.000) higher outpatient visits per person. Having a chronic condition increased the risk of attending outpatient services 12.5 times (P< 0.000). The number of outpatients visits per person for spouses was 1.96 times (P<0.000) that of dependents, while that of principals was 1.5 times (P=0.005) that of dependents. The relative risk for inpatients was comparable to 1. Conclusion Insurance schemes where individuals contribute part or all of the premium may have slightly less medical service utilization and subsequently less costly. Factors such as advancing age, chronic diseases, female gender also contribute to increased medical service utilization.