Determinants of health insurance uptake in Uganda households

Abstract

The study aimed at identifying determinants of uptake of health insurance among households in Uganda using the Uganda National Household Survey (UNHS) 2019/20 survey data. Data on 13,826 households where the respondent was the household head was analysed. The study used a complementary log-log model to explore the association between health insurance uptake and demographic, social and economic characteristics of the households. Throughout the analysis, survey weights were used and diagnostic test were performed to detect cases of multi-collinearity using the variance inflation factor (VIF) and pairwise correlation matrix.

The study revealed that household heads aged 60 and above had an odds ratio of 0.01, CI [0.00 - 0.17], implying that that they are less likely to take up insurance compared to those aged less than 35 years of age. In addition, households who earn Above Four Million Nine Hundred Twenty Thousand Uganda Shillings (UGX 4,920,000) a year (OR 6.7, CI: [2.0 - 22.9]), were 6.7 times more likely to take up insurance compared to those that earn less or equal to Two Million Eight Hundred Twenty Thousand Uganda Shillings (UGX 2,820,000). It was further established that household heads who receive income both in cash and in kind were also significantly (OR=0.3, CI [0.1 - 1.0]) less likely to take up insurance compared to those who receive income through the bank. Similarly, households who save in Secrete places or mobile money or in animal or save in assets (OR 0.3, CI: [0.1 – 0.9]) had a lower chance of taking up insurance compared to those who save in commercial banks. Lastly, the model revealed that households classified as neither poor nor rich (OR of 9.5, CI [2.7 - 33.6]), and those who classified themselves as rich (OR= 12, CI [2.5 - 57.4]), were 12 times more likely to take up insurance compared to those that considered themselves poor.

The study recommends that government aims at formalising the informal sector such that households are able to use financial institutions as a mechanism for saving. This is based on the fact that people who save in secrete places or mobile money or animal or assets were less likely to take up insurance. In addition, the study recommends that government should strengthen the fight against poverty given that household head in the higher category of annual income are more likely to take up insurance. Lastly, government, and other health insurance policy players should clearly communicate the rationale and direction of health insurance such that the general public appreciates and have a broader understanding of the health insurance as a concept.