Unveiling health insurance satisfaction: Exploring key determinants and bottlenecks in Bangladesh

Less than 1 % of the population in Bangladesh has access to health insurance (HI). Accordingly, the health care financing is largely reliant on out-of-pocket expenses. We explored determinants of client satisfaction with HI for a comprehensive model and made effort to identify the bottlenecks for HI expansion in Bangladesh. We used an explanatory sequential mixed-methods approach, surveying 291 active HI subscribers on satisfaction with service quality, claim settlement, premium, coverage, deductible, co-payment and company support. Experience-based perceptions on availing HI, premium payment, client service, claim settlement and HI benefit package were recorded on a Likert scale. Further, we conducted 25 key informant interviews to understand the bottlenecks for HI expansion in Bangladesh. We used thematic framework approach to analyse qualitative data. Principal Component Analysis was carried out to generate indices. Determinants of HI satisfaction were identified using multiple linear regression. Among experience-based perception domains, client service and claim settlement were key factors in HI satisfaction, with client service having a greater impact (coefficients: 0.45 and 0.30). Adding dependent healthcare and longer coverage enhanced client satisfaction. Though 74 % of clients were willing to recommend their HI scheme establishing good satisfaction level, issues related to low awareness, lack of specialized providers, high taxes, and an image crisis hinder HI expansion in Bangladesh Improving client satisfaction and hence, expanding HI market requires quality service and better claim settlement. Strengthening awareness and building the image for HI in Bangladesh need collaborative efforts. • Client service quality and claim settlement are the two important determinants for health insurance satisfaction. • Inclusion of dependents in the scheme increases the satisfaction of health insurance. • Lack of awareness, few specialized providers, and image crisis are key bottlenecks for health insurance expansion.