Health insurance coverage and health service utilisation in Uganda: an analysis of the 2016 Uganda Demographic and Health Survey

Abstract Background Health insurance is key in pooling resources for increased access to health services. There is currently no national health insurance scheme (NHIS) in Uganda and determining the profile of individuals with alternative health insurance can support future planning. The aim of this analysis was to explore the association between health insurance coverage and sociodemographic factors, health service utilisation and healthcare seeking behaviour in the 2016 Uganda Demographic and Health Survey (2016 UDHS). Methods Descriptive statistics and bivariate Pearson’s chi-square tests of association were conducted for 18,506 women and 5,336 men sampled in the 2016 UDHS. Significant variables at p < 0.05 informed the multivariable mixed effects Poisson regression analysis; this examined associations between health insurance coverage, sociodemographic factors, health service utilisation, and knowledge of insurance. Analyses were carried out using R Programming. Results Among the low proportion (1.4%) of individuals with health insurance, coverage widened with increasing wealth and education levels. Results of the regression analysis suggested a positive association between health service utilisation and being married, and increasing age, wealth, and knowledge of health insurance. Conclusions Findings demonstrated a very low health insurance coverage among the 2016 UDHS. Adjusting for wealth and age, higher education levels were positively associated with coverage, indicating the importance of education in understanding health risk. Beyond an inclusive approach for vulnerable population groups, strategies for the NHIS need to incorporate sensitisation to stakeholders on the need for a personal health safety net. Further work on exploring how to ensure equity and financial risk protection in the NHIS implementation may be key to informal sector inclusion.