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

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.