BACKGROUND:
Uganda's push for universal health coverage is hindered by high out-of-pocket payments,¹ persistent informal fees,² and extremely low insurance coverage (<2%).³,⁴ Evidence is limited on the prevalence of distress financing,⁵,⁶ patient characteristics associated with reliance on distress financing,⁷,⁸ and whether distress financing is associated with patient experience and satisfaction with care.⁹

METHODS:
We conducted a cross-sectional survey of 765 consecutively admitted patients across five Ugandan hospitals (four government, one private not-for-profit). Distress financing was defined as using family support, personal savings, or loans/borrowing to pay healthcare costs.⁷,¹⁰ We used multivariable logistic regression with robust standard errors to assess associations with patient characteristics (age, gender, employment, travel distance). Among paying patients with complete data (n=322), we explored associations with satisfaction domains.

RESULTS:
Overall, 40.7% (311/765) reported distress financing. In adjusted analysis, employed patients had higher odds of distress financing (aOR=1.54; 95%CI: 1.15–2.08; p=0.004), and odds increased modestly with age (aOR=1.01 per year; 95%CI: 1.00–1.03; p=0.013). Gender and travel distance were not significantly associated. Distress financing was not significantly associated with satisfaction measures in the paying sub-sample (n=322).

CONCLUSIONS:
Distress financing affected two in five hospitalized patients, with higher vulnerability among employed and older populations. Policy priorities include accelerating National Health Insurance implementation with subsidies targeting these groups, price regulation in private facilities, and emergency care financial protection mechanisms.