Is Health Care Financing in Uganda Equitable?

Introduction: Health care financing provides the resources and economic incentives for operating health systems and is a key determinant of health system performance. Equitable financing is based on: financial protection; progressive financing and cross-subsidies. This paper describes Uganda's health care financing landscape and documents the key equity issues associated with the current financing mechanisms. Methods: We extensively reviewed government documents and relevant literature and conducted key informant interviews; with the aim of assessing whether Uganda's health care financing mechanisms exhibited the key principles of fair financing. Results: Uganda's health sector remains significantly under-funded; mainly relying on private sources of financing; especially out-of-pocket spending. At 9.6of total government expenditure; public spending on health is far below the Abuja target of 15that GoU committed to. Prepayments form a small proportion of funding for Uganda's health sector. There is limited cross-subsidisation and high fragmentation within and between health financing mechanisms; mainly due to high reliance on out-of-pocket payments and limited prepayment mechanisms. Without compulsory health insurance and low coverage of private health insurance; Uganda has limited pooling of resources; and hence minimal cross-subsidisation. Although tax revenue is equitable; the remaining financing mechanisms for Uganda are inequitable due to their regressive nature; their lack of financial protection and limited cross-subsidisation. Conclusion: Overall; Uganda's current health financing is inequitable and fragmented. The government should take explicit action to promote equitable health care financing by establishing pre-payment schemes; enhancing cross-subsidisation mechanisms and through appropriate integration of financing mechanisms

Will Private Health Insurance Schemes Subscriptions Continue after the Introduction of National Health Insurance in Uganda?

Introduction: Uganda is currently designing a National Health Insurance (NHI) scheme; with the aim of raising additional resources for the health sector. Very little was known about the health insurance market in Uganda before this study; so one of our main objectives was to investigate the nature of the private health insurance market in Uganda and the opinions of various stakeholders on NHI; with the view to establish the impact of NHI implementation on the existing PHI. Specifically; we aimed to gather the opinions of employees and employers on the likely impact of NHI on their PHI schemes. Methods: We conducted interviews with health insurance providers; and a sample of employers and employees in Kampala; using structured questionnaires and analysed quantitative data using STATA8. Qualitative data was analysed through grouping of emerging themes. Community-based health insurances were excluded from the study. Results: Health insurance and/or prepayment schemes are offered by a handful of organisations or private health providers; mainly in Kampala and cover a relatively small percentage of Uganda's population. The premiums charged and the benefit packages offered by the different agencies vary widely. There are 2 health insurance agencies; 2 HMOs and about 5 or more private providers offering pre-payment schemes to their patients. Responses from a significant proportion of employers and employees show that PHI schemes may be abandoned once the mandatory NHI scheme is implemented. A few respondents argued that they would maintain their PHI subscriptions because of their perceptions of the quality of services likely to be provided under the NHI scheme. Conclusion: If successfully introduced; the NHI scheme may displace existing private health insurance and/or pre-payment schemes in Uganda. The extent to which PHI schemes are displaced depends on whether NHI is successfully implemented and the quality of services being offered under the NHI scheme