Expectations of clients, insurers, and providers: A qualitative responsiveness assessment among private health insurance sector in Kampala-Uganda

Abstract

Abstract Background There is less attention on assessing how health services meet the expectations of private health insurance actors in developing countries. During contractual negotiations, duties, obligations and privileges of the client, insurer and the provider in a health insurance arrangement are stipulated. Interdependently, service roles are ideally supposed to be performed while complementing each actor’s efforts aimed at meeting their expectations. This study assessed how these expectations were met to inform the nature of support to extend to Uganda’s intended national health insurance scheme. Methods This study employed a qualitative case-study design. Ten (10) Focus group discussions (FGDs) with insured clients and eleven (11) Key Informant Interviews (KIIs) with Insurer and Provider liaison officers between October to February 2021 were conducted. Participants were purposively selected from eligible institutions. Thematic analysis was employed, and findings were presented using themes with corresponding anonymized narratives and quotes. Results Client-Provider, Client-Insurer and Provider-Insurer expectations were generally not met. Client-Provider expectations; Although most facilities were clean with a conducive care environment, clients experienced low service care responsiveness characterized by long waiting time. Both clients and providers received inadequate feedback about services they received and delivered respectively in addition to prompt care being received by a few clients. For Client-insurer expectations; under unclear service packages, clients received low quality medicines. Lastly, for provider-insurer expectations; delayed payments, selective periodic assessments, and inadequate orientation of clients on insurance plans were most reported. Weak coordination between the Client-Provider and Insurer did not support delivery processes for quality service. Conclusion Health care service responsiveness was generally low. There is need for committing resources to support setting up of clearer service package orientation programs, and efficient monitoring and feedback platforms. Uganda’s proposed National Health Insurance Act may use these findings to inform its design initiatives that will focus on operating under realistic expectations, investment in quality improvement systems and client care relationships while using well calibrated accountability tools.