Use of Out-of-Plan Services by Health Insurance Beneficiaries in Alexandria
W, G., M, N., A, Z. (2021). Use of Out-of-Plan Services by Health Insurance Beneficiaries in Alexandria. EKB Journal Management System, 33(1), 173-194. doi: 10.21608/jhiph.2021.201369
Guirguis W. W; Nour El-Din M. M; Zaghloul A. A. "Use of Out-of-Plan Services by Health Insurance Beneficiaries in Alexandria". EKB Journal Management System, 33, 1, 2021, 173-194. doi: 10.21608/jhiph.2021.201369
W, G., M, N., A, Z. (2021). 'Use of Out-of-Plan Services by Health Insurance Beneficiaries in Alexandria', EKB Journal Management System, 33(1), pp. 173-194. doi: 10.21608/jhiph.2021.201369
W, G., M, N., A, Z. Use of Out-of-Plan Services by Health Insurance Beneficiaries in Alexandria. EKB Journal Management System, 2021; 33(1): 173-194. doi: 10.21608/jhiph.2021.201369

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

Journal of High Institute of Public Health
Article 13, Volume 33, Issue 1, January 2003, Page 173-194  XML
Document Type: Original Article
DOI: 10.21608/jhiph.2021.201369
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Authors
Guirguis W. W1; Nour El-Din M. M1; Zaghloul A. A2
1Hospital Administration Division, Health Administration and Behavioral Sciences Department, High Institute of Public Health, University of Alexandria, Egypt
2Health Planning and Administration Division, Health Administration and Behavioral Sciences Department, High Institute of Public Health, University of Alexandria, Egypt
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
Out-of-Plan Services; Health Insurance Beneficiaries; Alexandria
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