Use of Out-of-Plan Services by Health Insurance Beneficiaries in Alexandria

W, Guirguis W.; M, Nour El-Din M.; A, Zaghloul A.

doi:10.21608/jhiph.2021.201369

Use of Out-of-Plan Services by Health Insurance Beneficiaries in Alexandria

Document Type : Original Article

Authors

¹ Hospital Administration Division, Health Administration and Behavioral Sciences Department, High Institute of Public Health, University of Alexandria, Egypt

² Health Planning and Administration Division, Health Administration and Behavioral Sciences Department, High Institute of Public Health, University of Alexandria, Egypt

10.21608/jhiph.2021.201369

Abstract

Out-of-plan use is any service obtained by a plan member from a non-plan physician or other allied health professionals. The following study examines services obtained by health insurance beneficiaries from non-health insurance physicians. Reasons why persons who enjoy a comprehensive health care coverage go to non-plan providers for services they could obtain from HIO providers at no cost. Obtaining health services by health insurance beneficiaries from non-health insurance physicians was also examined in the present work. The study was conducted at 3 Health Insurance Organization [HIO] clinics in Alexandria. A pre-coded interview questionnaire was used to gather the required information from 610 randomly selected beneficiaries. The study revealed high pattern of out-of-plan use by HIO beneficiaries; 66.6% utilized at least one out-of-plan per year. Beneficiary characteristics associated with out-of-plan use were quality rating of services, perceived health status, seeking second opinion, education and the number of chronic diseases. The mean out of pocket expenditure on last out-of-plan visit was 100 LE. The implications for the Health Insurance Organisation and financing of health services are discussed.

Keywords