Factors influencing demand for health insurance in households with children aged 0-5 years in Uganda

Abstract

The study aimed to analyze the factors influencing demand for health insurance among Ugandan households with children 0-5years , using data from the 2019/2020 Uganda National Household Survey (n=3,588). Applying a binary logistic regression model, the univariate analysis found that most households were rural (82%), about half were female-led (50.7%), with fathers engaged in either subsistence work or unemployed (54.3%) and mothers being self-employed (35.2%) or in subsistence work/unemployed (61.7%). Health shocks were common, and households mostly sought care from private healthcare within 5 km, while family members were the primary caregivers. Only 18.6% of households expressed interest in joining a health insurance Scheme. The key determinants for joining a health insurance scheme include, region, income level, father’s type of employment, health seeking behavior and living in an urban area. The factors which are significantly associated with joining healthcare insurance include; region (p = 0.000), father’s type of employment (p = 0.040), healthcare-seeking (p = 0.032), source of healthcare accessed (p = 0.073), primary caregiver during illness (p = 0.029), and mode of transport to healthcare facilities (p = 0.019).other factors associated with joining health insurance were household income (p = 0.000), frequency and duration of illness episodes in the past 30 days (p = 0.000; p = 0.023). The logistic regression results showed that households in the Eastern region were 11.7% more likely to demand insurance compared to the Central region (p = 0.010). However, the demand for health insurance for those in the Northern and Western was lower by 8.3% (p = 0.050) and 9.4% (p = 0.056) compared to central region respectively. These findings suggest the need for targeted interventions in the Northern and Western regions, where demand is lowest, to help raise health insurance uptake. Affordable insurance products tailored for subsistence and low-income working households is also important to reduce the financial barriers and improve health insurance uptake. Enhancing the quality of care, and accessibility to public healthcare, especially for low-income households, are key factors in encouraging enrolment in health insurance schemes. To increase the likelihood of taking up health insurance, targeted awareness campaigns in rural and low-income areas should focus on educating households about the benefits of insurance in reducing healthcare costs during emergencies. Improved transportation system to healthcare facilities is associated with better health-care seeking behavior and could increase the perceived value of health insurance.