RESUMO
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