Use of out-of-plan services by health insurance beneficiaries in Alexandria

ABSTRACT

This study examined the services obtained by the Health Insurance beneficiaries from non-health insurance physicians. Obtaining health services by Health Insurance beneficiaries from non-health insurance physicians was also examined in the present work. The study was conducted at three Health Insurance Organization [HIO] clinics in Alexandria. A pre-coded interview questionnaire was used to gather the required information from 610 randomly selected beneficiaries. The study revealed a high pattern of out-of-plan use by HIO beneficiaries, 66.6% utilized at least one out-of-plan per year. The beneficiary characteristics that are associated with the out-of-plan use were quality rating of services, perceived health status, seeking second opinion, education and the number of chronic diseases. The mean out of pocket expenditure at the last out-of-plan visit was LE 100. The implications for the Health Insurance Organization and financing of health services were discussed