Uganda’s medical insurance industry players have called for stronger collaboration, better use of data and technology, and improved medical claims oversight to address rising healthcare costs and ensure the sustainability of medical insurance schemes.
The call was made during the unveiling of the 2026 Quarter One to Quarter Three Medical Insurance Industry Report by Smart Applications International Uganda Ltd in partnership with the Uganda Insurers Association (UIA).
The report, unveiled under the theme “Transforming Medical Insurance Through Data, Intelligence and Technology,” brings together information covering approximately 80 per cent of Uganda’s medical insurance market, providing insights into claims trends, healthcare utilisation and the performance of medical service providers.
Speaking at the event, Judy Elaine Mugoya, the Country Manager of Smart Applications International, said the report was part of a broader effort to establish an industry-wide information-sharing platform that would enable stakeholders to make informed decisions.
Judy Elaine Mugoya, the Country Manager of Smart Applications International
“Indeed, this is just the beginning of the journey. The interactions are now going to be more solid as we continue this collaboration. This is not one of those events that starts and stops, and we are not going to be marked or defined by just the release of this report,” Mugoya said.
She noted that although the current report represents close to 80 per cent of the medical insurance industry, Smart Applications intends to expand its coverage to capture the entire market.
“Our challenge is that we want to be able to represent 100 per cent of what the industry is actually saying. Through an independent technology platform, we shall be able to reflect that information,” she added.
Mugoya said the platform would also provide alerts to help insurers and medical service providers identify fraud, waste and abuse, which have become important concerns in the management of medical claims.
Badru Bengo, a Senior Technical Officer – Life Pension and Medical at Uganda Insurers Association (UIA), said the report addresses a longstanding information gap in the industry, where individual insurance companies and hospitals have been relying on fragmented data that limits their ability to identify wider industry trends.
“Each company has a component of it and each hospital has a component of it. So, the link to include all this information under one platform is what has been lacking,” Bengo said.
He said bringing the information together would strengthen claims oversight, improve intelligent claims scrutiny and help stakeholders identify unusual patterns that might otherwise go unnoticed.
Bengo added that the availability of periodic reports would allow industry players to monitor developments and make more informed decisions.
He urged insurers, healthcare providers, employers and other stakeholders to embrace the platform, saying Smart Applications had agreed to make the reports available quarterly, half-yearly and annually.
Meanwhile, Gilbert Owori, the Chief Finance Officer of Bugoloobi Medical Centre, attributed rising medical claims costs partly to increased investments in the healthcare sector, the rising cost of medical supplies and pharmaceuticals, and delays in settling hospital bills.
Owori said the expansion of healthcare facilities had increased pressure on providers to recover their investments, contributing to rising medical charges.
“Whenever investments are happening, especially into that particular industry, there should be some effects which we are facing now,” he said.
He also revealed that his facility had received price adjustment notices from about 30 per cent of its suppliers, affecting the cost of medicines and laboratory reagents.
“At our facility, we have, as we speak now, received price reviews from 30 per cent of our suppliers. This means that we have to get on our negotiating tables with insurance,” Owori said.
He further called for fairer pricing arrangements across healthcare facilities, arguing that hospitals should not charge significantly different fees for similar services provided by the same medical professionals.
However, he identified delayed payments by insurance companies as one of the biggest challenges facing healthcare providers, saying outstanding bills sometimes accumulate for up to five months.
“Hospitals find themselves always in a world of distortion because this money does not come on time. You find accumulation of bills for five months,” he said.
Owori also challenged the regulator to regularly assess the performance of insurance companies in their dealings with healthcare providers, arguing that such evaluations would help address longstanding disagreements between the two sides.
Winnie Kiwuuwa, the Chief Operating Officer of Minet Uganda, said access to reliable industry data would enable insurance brokers to offer better advice to clients instead of relying on the traditional approach of increasing premiums or reducing medical benefits whenever claims rise.
“For many years, the conversations at medical insurance renewals with clients and insurers have always followed a familiar pattern: claims are increasing, insurers propose higher premiums and the client is left with only two choices, either to pay more premium or reduce the cover,” Kiwuuwa said.
She said the new report would help brokers understand the actual drivers of medical claims, benchmark their clients’ insurance schemes against industry trends and recommend appropriate interventions.
Kiwuuwa also called for greater inclusion of mental healthcare in medical insurance packages, warning that limited coverage could leave mental health conditions unmanaged until they develop into more serious illnesses.
She cited relationship and social challenges, career-related pressures, substance abuse, depression, anxiety and trauma among the issues emerging from mental health-related cases handled through employee assistance programmes.
“What I am suggesting is that maybe we have mental health as part of the core cover, just like physical illness, including access to service providers,” she said.
She further called for insurance companies to expand their networks to include independent counsellors and psychotherapists while strengthening workplace wellness programmes.
On her part, Joan Nankya, Head of Medical at ICEA Lion Uganda, said insurers needed to redesign medical insurance products to reflect the actual healthcare needs of their clients, particularly young families.
She noted that the report showed a relatively young insured population, with many beneficiaries falling within the 30–40 age bracket and having family responsibilities.
Nankya said the high utilisation of outpatient services, which accounts for about 70 per cent of overall claims expenditure, should prompt insurers to investigate the reasons behind frequent hospital visits rather than simply impose restrictions.
“The focus should not really be on whether we limit outpatient benefits, but we should, through data, understand what is driving the outpatient utilisation,” she said.
She suggested that insurers invest more in health education, preventive healthcare and coordinated interventions to reduce unnecessary hospital visits.
Nankya also pointed to the growing burden of chronic illnesses, noting that about 11 per cent of the observed patient population had chronic conditions.
She said insurers should go beyond providing treatment limits and introduce structured disease-management programmes involving regular screening, medication adherence and follow-ups.
“If we use a case of hypertension, it is better to prevent the patient from progressing to a stroke or a kidney complication. As insurers, our value should not be more in the benefit that we have given, but in how much we can prevent hypertension from becoming a stroke,” she said.
Dr Edrin Jjuuko, Head of Medical Business at Old Mutual also called for improved medical practices and closer scrutiny of diagnostic procedures, warning that unnecessary investigations and treatment could be contributing to rising claims costs.
He observed that although overall medical expenditure was increasing, the number of hospital visits was declining, suggesting that stakeholders needed to examine the nature and intensity of treatment being provided.
Jjuuko recounted an experience in which a doctor recommended an X-ray for a minor ankle injury without physically examining him.
“I was a bit shocked because I have practised for over 14 years, and I didn’t understand why I needed an X-ray in that instance. Also, he had not examined me at all,” he said.
He argued that such practices could lead to unnecessary claims and called for renewed emphasis on proper patient examination before ordering diagnostic tests.
Jjuuko also proposed using artificial intelligence to support doctors in identifying unnecessary investigations at the point of consultation rather than relying solely on technology to detect questionable claims after treatment and billing.
“I think there’s a need to go back to the drawing board on the cost of medical services and also encourage medical providers to do the needful, examining the patient and choosing the right investigations,” he said.
He added that the industry needed to distinguish between increases caused by providers raising their prices and those resulting from more intensive or complex medical treatment.
The stakeholders agreed that strengthening collaboration among insurers, brokers, hospitals, employers, technology providers and regulators would be critical to improving transparency, controlling costs and ensuring that medical insurance remains affordable and sustainable.
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