# Factors Related to Client Satisfaction with Community Based Health Insurance Services During COVID-19 Pandemic in Central Uganda: A Mixed Methods Healthcare Facility Based Study

## TL;DR

This study explores client satisfaction with health insurance services in Uganda during the pandemic, finding that factors like distance and waiting times significantly impact satisfaction.

## Contribution

The study identifies specific factors affecting client satisfaction with community-based health insurance during the pandemic, offering actionable insights for service improvement.

## Key findings

- Only 38.9% of clients were satisfied with CBHI services during the pandemic.
- Longer distances to healthcare facilities and longer waiting times reduced satisfaction.
- Higher education and good knowledge of the scheme were associated with lower satisfaction.

## Abstract

During the COVID-19 lockdowns, healthcare services were disrupted and community-based health insurance (CBHI) schemes could not operate efficiently. This study assessed the level of client satisfaction with CBHI schemes, associated factors, and service provider perspectives in central Uganda.

This was an explanatory sequential mixed-methods (quantitative - qualitative) study that was conducted between March and September 2021. In the first phase, a cross-sectional study among the 365 clients of the CBHI schemes who were aged ≥18 years old. The participants were recruited consecutively as they reported to the healthcare facility. Quantitative data were collected at patient exit using a piloted semi-structured interviewer-administered questionnaire. In the second phase, qualitative data were collected through 11 key informant interviews. These data were analyzed using a deductive thematic analysis approach. Modified Poisson regression was used to assess factors associated with client satisfaction and a p-value ≤0.05 at a 95% confidence interval was considered to be statistically significant.

Of the total number of participants, 38.9% (142/365) were “satisfied” with the CBHI services. Less satisfaction was associated with secondary level of education or above (adjPR = 0.55, 95% CI: 0.36–0.85, P=.007); residing beyond 16 kilometers from the healthcare facility (adjPR = 0.68, 95% CI: 0.41–0.95, P=.014); staying on the scheme for over 3 years (adjPR = 0.71, 95% CI: 0.51–0.99, P=.046); and good knowledge about the CBHI (adjPR = 0.76, 95% CI: 0.58–0.99, P=.040). Irregular availability of healthcare workers and long waiting time affected client satisfaction.

Satisfaction was considerably low during the lockdown. Lockdowns due to pandemics interrupt healthcare services and subsequently affect the satisfaction of CBHI clients with scheme services. Scheme managers need to identify facilities that are closer to enrolees and invest in technologies that reduce waiting time in the healthcare facility.