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Adopting social health insurance in Nepal: A mixed study

OBJECTIVE: The Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financia...

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Autores principales: Paneru, Damaru Prasad, Adhikari, Chiranjivi, Poudel, Sujan, Adhikari, Lal Mani, Neupane, Deepak, Bajracharya, Juli, Jnawali, Kalpana, Chapain, Kamal Prasad, Paudel, Nabaraj, Baidhya, Nirdesh, Rawal, Ashok
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9798538/
https://www.ncbi.nlm.nih.gov/pubmed/36589957
http://dx.doi.org/10.3389/fpubh.2022.978732
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author Paneru, Damaru Prasad
Adhikari, Chiranjivi
Poudel, Sujan
Adhikari, Lal Mani
Neupane, Deepak
Bajracharya, Juli
Jnawali, Kalpana
Chapain, Kamal Prasad
Paudel, Nabaraj
Baidhya, Nirdesh
Rawal, Ashok
author_facet Paneru, Damaru Prasad
Adhikari, Chiranjivi
Poudel, Sujan
Adhikari, Lal Mani
Neupane, Deepak
Bajracharya, Juli
Jnawali, Kalpana
Chapain, Kamal Prasad
Paudel, Nabaraj
Baidhya, Nirdesh
Rawal, Ashok
author_sort Paneru, Damaru Prasad
collection PubMed
description OBJECTIVE: The Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence. METHODS: A cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings. RESULTS AND PROSPECTS: Of a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30–290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3–393.9) and accessibility (OR = 74.4; 95% CI, 42.5–130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts. CONCLUSION: Although enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.
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spelling pubmed-97985382022-12-30 Adopting social health insurance in Nepal: A mixed study Paneru, Damaru Prasad Adhikari, Chiranjivi Poudel, Sujan Adhikari, Lal Mani Neupane, Deepak Bajracharya, Juli Jnawali, Kalpana Chapain, Kamal Prasad Paudel, Nabaraj Baidhya, Nirdesh Rawal, Ashok Front Public Health Public Health OBJECTIVE: The Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence. METHODS: A cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings. RESULTS AND PROSPECTS: Of a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30–290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3–393.9) and accessibility (OR = 74.4; 95% CI, 42.5–130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts. CONCLUSION: Although enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered. Frontiers Media S.A. 2022-12-15 /pmc/articles/PMC9798538/ /pubmed/36589957 http://dx.doi.org/10.3389/fpubh.2022.978732 Text en Copyright © 2022 Paneru, Adhikari, Poudel, Adhikari, Neupane, Bajracharya, Jnawali, Chapain, Paudel, Baidhya and Rawal. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Paneru, Damaru Prasad
Adhikari, Chiranjivi
Poudel, Sujan
Adhikari, Lal Mani
Neupane, Deepak
Bajracharya, Juli
Jnawali, Kalpana
Chapain, Kamal Prasad
Paudel, Nabaraj
Baidhya, Nirdesh
Rawal, Ashok
Adopting social health insurance in Nepal: A mixed study
title Adopting social health insurance in Nepal: A mixed study
title_full Adopting social health insurance in Nepal: A mixed study
title_fullStr Adopting social health insurance in Nepal: A mixed study
title_full_unstemmed Adopting social health insurance in Nepal: A mixed study
title_short Adopting social health insurance in Nepal: A mixed study
title_sort adopting social health insurance in nepal: a mixed study
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9798538/
https://www.ncbi.nlm.nih.gov/pubmed/36589957
http://dx.doi.org/10.3389/fpubh.2022.978732
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