Health Microinsurance in Uganda: Affecting Malaria Treatment Seeking Behavior

Low-income and rural populations often delay seeking treatment for malaria. Delays in seeking treatment increase the likelihood of mortality and add to the cost of treatment. Delaying health care can also increase hospital admissions and add further burden to strained health systems in developing countries. Interventions that prompt early diagnosis and treatment can reduce delays and rates of hospital admission, resulting in decreased costs to the clients, the health system, and health microinsurance (HMI) schemes. Further, understanding determinants of health seeking behavior would be useful in planning malaria control strategies. Case study reports and anecdotal information obtained through interviews revealed certain benefits to the use of healthcare microinsurance. HMI users are less likely to be financially vulnerable to health crisis when the HMI system works. However, there was no scientific evidence to suggest that participation in a HMI plan made a difference in healthcare behavior. Whether HMI clients would seek healthcare sooner likely would influence improved health outcomes over their non-HMI user counterparts. Hence, this case study explores ways that health care microinsurance influences malaria treatment-seeking behavior in Uganda. Using concepts from the Health Belief Model researchers developed a questionnaire made of semi-structured interviews that were conducted at three sites in Uganda. A multi-site case comparison study provided qualitative and quantitative results from 234 interviews conducted over a three-month period in 2003 in Kisiizi, Kampala, and Ishaka, Uganda. These were conducted with HMI users and non-users. The interviews consisted of open and closed-ended questions. Quantitative data were analyzed using SAS software. The qualitative data were analyzed using NVIVO software. Results from the study indicate that users and non-users of HMI felt malaria was serious, that they were susceptible to the illness, and that there were benefits to going for care early in the disease cycle. However, there was a significant difference in how long it took users versus non-users of HMI to access care. Findings showed that people who had HMI were more likely to go for care earlier once they realized they were ill, compared to those without HMI. Further, people who had microinsurance were less likely to be admitted to the hospital than non-users. Users were more likely than non-users to mention transportation as a barrier to access. Conversely, non-users were more likely to indicate cost of care caused them to delay seeking care when they felt that they should go for biomedical services. The implications of this study are far reaching. The results of this study suggest that, in addition to reducing financial vulnerability, HMI has the potential to reduce malaria morbidity and the cost of care through early treatment.