PONE-D-22-25883THE FEASIBILITY ANALYSIS OF INTEGRATING COMMUNITY-BASED HEALTH INSURANCE SCHEMES INTO THE NATIONAL HEALTH INSURANCE SCHEME IN UGANDAPLOS ONE

Dear Dr. Namyalo,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Jamie Males

Editorial Office

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: ABSTRACT

Background - I would suggest you change the statement " where the rich will subsidize the treatment of the poor and the healthy will subsidize the treatment of the sick, young and elderly" to "where the rich will subsidize the treatment of the poor, the healthy will subsidize the treatment of the sick, and young will subsidize the treatment of the elderly".

Method - This is a cross-sectional study with qualitative data collection method and review of documents. The study design stated here is questionable? Some of the data collection methods mentioned such as questionnaires, observations and archive were not performed or reported in the study.

Result - Give the USD equivalent of the UGX 75,215

Conclusion- How did the authors arrive at this conclusion? The result presented in the abstract did not show this.

TEXT

General comments - The write-up seems too lengthen. There are minor grammatical errors that need to be corrected. Abbreviations should be used in full the first time, before their subsequent use. The United States Dollar equivalent of the money stated within the text should be included.

Introduction - The authors gave a good background on the topic, showed the gap in knowledge and stated the aim of the study.

Methods

Study settings- How were the districts selected? What sampling method was used? Please give details of the sampling technique.

Data collection methods-

1. I would suggest the first statement in this subsection is moved to the study design

2. Who were the questionnaires administered to? How was the data from the questionnaire analyzed?

3. What was observed? where were the observations carried out?

4. What do you mean by archive as a method?

5. All I saw reading through the methods were Reviews of literature and other documents, Key Informant Interviews and Secondary data analysis

RESULT AND DISCUSSION

These were merged in the write up

I would suggest the authors separate the results from the discussion

Lessons learnt

ow did you come about some points such as "Another important lesson is that long distances and high costs of transport to healthcare providers undermine enrolment. Some people were not joining CBHIS whose service providers were perceived to be far especially if they had alternatives" and "Furthermore, we learned that some families fail to pay the premiums when they have conflicting interests, especially in school fees payments and festival seasons coinciding with premium payments. Whenever CBHI renewal periods overlap with school fee periods, it affects retention in CBHIs". The result section did not mention these points as findings of the study but were raised as part of lessons learns

CONCLUSION

Paragraph 6, line 4 - I would suggest you change the statement " where the rich will subsidize the treatment of the poor and the healthy will subsidize the treatment of the sick, young and elderly" to "where the rich will subsidize the treatment of the poor, the healthy will subsidize the treatment of the sick, and young will subsidize the treatment of the elderly".

Other comments are within the manuscript

Reviewer #2: The paper provides a comprehensive account of Uganda's existing community-based health insurance schemes

(CBHIS). It also examines the feasibility of integrating the CBHIS into a national health insurance scheme. I enjoyed reading the paper; very insightful. I particularly like how the authors relate Uganda's case to other sub-Saharan African countries (Ghana, Rwanda Tanzania). I have a few minor comments, notwithstanding.

The first relates to the use of abbreviations. Please check all for consistency (e.g., should readers assume CBHIS, CBHI, CBHIs, CHBIS CHBIs are used interchangeably? Also see DMHIS DMHIs). Ensure all abbreviations are defined upon first use (see CHI, SACCOs, CBO).

Second, some sentences need to be checked. e.g.,

i. "The effort towards the creation of a national scheme comes at a time when there already existing CBHIS." (are missing?)

ii. "Most of the reasons pointed to the need to accelerate achieving universal health coverage since the majority of the population." (Is that an incomplete sentence?)

Third, I found it hard understanding the use of e.g. "1000/=". Please feel free to ignore this comment if it is a standard approach which I simply do not know.

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Reviewer #1: Yes: Tope Michael Ipinnimo

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-22-25883_reviewer.pdf

PONE-D-22-25883R1THE FEASIBILITY ANALYSIS OF INTEGRATING COMMUNITY-BASED HEALTH INSURANCE SCHEMES INTO THE NATIONAL HEALTH INSURANCE SCHEME IN UGANDAPLOS ONE

Dear Dr. Namyalo,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Mar 24 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-emailutm_source=authorlettersutm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Gilbert Abotisem Abiiro, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

1. Questionnaire is an instrument of collecting data but not a method of data collection. Replace questionnaire with the appropriate method of data collection in the abstract

2. All abbreviations used in the abstract should be written in full or defined within the abstract (eg: CHI and CBHI)

3. Please ensure that the manuscript is thoroughly proofread before resubmission

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: Many thanks for addressing my concerns. It appears the paper still has "CHBIS". Please define upon first use or correct if you mean CBHIS. (see "Integration of CHBIS...")

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Ipinnimo T.M.

Reviewer #2: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

THE FEASIBILITY ANALYSIS OF INTEGRATING COMMUNITY-BASED HEALTH INSURANCE SCHEMES INTO THE NATIONAL HEALTH INSURANCE SCHEME IN UGANDA

PONE-D-22-25883R2

Dear Prossy Kiddu Namyalo,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Gilbert Abotisem Abiiro, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: