Metrics details. There is less attention to assessing how health services meet the expectations of private health insurance PHI actors, clients, insurers, and providers in developing countries.
Interdependently, the expectations of each actor are stipulated during contract negotiations duties, obligations, and privileges in a PHI arrangement. Complementary service roles performed by each actor significantly contribute to achieving their expectations. This study assessed the role of PHI in meeting the expectations of clients, insurers, and providers in Kampala. This study employed a qualitative case-study design. Eight 8 focus group discussions FGDs with insured clients and nine 9 key informant interviews KIIs with insurer and provider liaison officers between October and February 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. Client-provider expectations: Although most facilities were clean with a conducive care environment, clients experienced low service care responsiveness characterized by long waiting times.
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 responsive service.
