Review of Social Health Insurance Scheme in Selected Districts of Nepal



Active


2017/18


NPR 1 Million


Social Health Security Development Committee, Ministry of Health


Kailali, Baglung and Illam


Most health care in Nepal is paid out-of-pocket often incurring a significant portion of the income of individual household leading to catastrophic health expenditure. Previous studies have shown that 13.8% of the study households had experienced catastrophic expenditure on health in the 30 days before interview in Nepal. Insurance has received huge political commitment and has emerged as a reform strategy in recent years. Although the concept of health insurance (HI) is not new in Nepal, social health insurance with universal coverage seems challenging considering present poverty level, awareness regarding need and working modality of health insurance among the general population and availability and access to quality health care services. Furthermore, the government has the plan for subsidizing premium for the poor population who are not able to pay for the insurance package. This tends to incur significant financial expenses to the government of Nepal besides administrative cost in the implementation of the package. In this context, the experiences in implementing health insurance need to be regularly reviewed considering the coverage, inclusiveness of vulnerable population,thefinancial viability of the scheme for the improvement efficiency and effectiveness of the insurance.


This study has been planned with the aimn of documenting experiences while implementing insurance, identifying key challenges faced and assessing the financial viability of the insurance scheme in selected districts of Nepal.


The study will identify key challenges in the implementation of health insurance. It will document valuable experiences of health personnel involved in the delivery of health services. The research will provide useful information on the performance of health insurance in selected districts including coverage, resource generation and financial viability of the health insurance scheme.