Effect of universal health insurance implementation on beneficiaries' evaluation of public health facilities in Egypt - a cross-sectional study.

Publisher: BioMed Central Country of Publication: England NLM ID: 101147692 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-9276 (Electronic) Linking ISSN: 14759276 NLM ISO Abbreviation: Int J Equity Health Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2002-

Universal Health Insurance*/statistics & numerical data ; Health Facilities*/standards ; Health Facilities*/statistics & numerical data ; Patient Satisfaction*/statistics & numerical data; Humans ; Cross-Sectional Studies ; Egypt ; Male ; Female ; Adult ; Middle Aged ; Health Services Accessibility/statistics & numerical data ; Surveys and Questionnaires ; Quality of Health Care

Competing Interests: Declarations. Ethics approval and consent to participate: The study proposal was approved by the IRB of Harvard Faculty of Medicine (IRB21-0337) on 5/10/2021. Further approvals were granted by the Egyptian’s MoHP, and Egypt Healthcare Authority before data collection. This study was conducted in accordance with the Declaration of Helsinki. All participants gave their informed consent before proceeding with the study procedures. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
Background: Universal health coverage (UHC) is a key health policy priority to guarantee access to high-quality healthcare without causing undue financial hardship. After many attempts for health reform, Egypt has adopted the Universal Health Insurance (UHI) system in 2018. The aim of the study was to assess the effect of UHI implementation on beneficiaries' perspectives of public healthcare facilities during the early stages of implementation.
Methods: A cross-sectional study was conducted from 2021 to 2022 in Egypt, with 785 participants interviewed at UHI and non-UHI areas. All participants were interviewed using a questionnaire for sociodemographic characteristics, perceived health status, insurance plan, and Patient Evaluation Scale -Short form (PES-SF). Besides, participants were asked to report their general evaluation of overall quality, accessibility, and satisfaction with the healthcare services.
Results: Out of 785 participants, 326 participants were UHI beneficiaries, while 459 were non-UHI enrollees. UHI was associated with a 4.71-point increase in the mean total PES-SF score compared to non-UHC (95% CI: 3.12-6.30, p < 0.001). UHI was associated with an 80% and 56% increase in the likelihood of reporting a good or more overall accessibility and general satisfaction with health facilities, compared to non-UHI, respectively (OR: 1.80, 95% CI: 1.17-2.77, p = 0.008; OR: 1.56, 95% CI: 1.00-2.43, p = 0.048, respectively). However, perceived overall quality was not significantly associated with UHI status (OR: 1.13, 95% CI: 0.74-1.71, p = 0.578).
Conclusions: The study finding shows that UHI beneficiaries perceived a higher level of overall satisfaction and accessibility than non-UHI beneficiaries. However, no significant difference exists regarding the perceived overall quality of care. These findings provide valuable insights into the effect of UHI in Egypt and can inform evidence-based policymaking to strengthen the healthcare system and advance universal health coverage objectives.
(© 2025. The Author(s).)

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001 International WHO_ World Health Organization

Keywords: Accessibility; Egypt; Health insurance; Patient satisfaction; Perceived quality; Universal health coverage

Date Created: 20250228 Date Completed: 20250510 Latest Revision: 20250605

20250605

PMC11871787

10.1186/s12939-025-02402-9

40022187