The first step for health insurance in Nepal has been taken back in the 1970s from the non – government sector and that was community-based. Later, in the 1980s and 1990s. In 2003, the Ministry of Health and Population piloted Community based Health Insurance in six public health facilities. Despite all these scattered efforts, out-of-pocket payment was still high in Nepal. None of the efforts was scaled up to cover more areas. In this scenario, National Health Insurance Policy was launched in 2013 with the aim to increase financial protection of the public by promoting pre-payment and risk pooling in the health sector, mobilize financial resources in an equitable manner, and improve the effectiveness, efficiency, accountability and quality of care in the delivery of health care services.
Following the policy, Social Health Security Development Committee was formed in 2014, which after two years of background work, including feasibility study, launched the Social Health Security Program in 2016, now known as the National Health Insurance Program. It was initially started in three districts viz. Kailali, Baglung and Ilam and now fully expanded up to 49 districts while the basic training has been completed up to 58 districts. However, the insurance program faces various challenges, including population coverage and renewal. Only 18% of the total population of those districts are enrolled which is very low of their next year target of 50%.
The Health Insurance Act in 2017 has a provision of mandatory enrollment for all the family members including family members of governmental employees, employees of private organizations, migrant workers, newborn, children and elderly citizen. This obligatory provision is a great policy shift from the previous provision of a voluntary nature. Also, to ensure social equity in health, subsidies is provided to the poor, disabled and disadvantaged population. Following this mandate, the Health Insurance Regulation-2019 has delineated the Act by ensuring full subsides in the contribution amount of family members of the ultra-poor, elderly population, seriously disabled, Leprosy, HIV, MDR-TB patients while half subsidies for the family members of Female Community Health Volunteers (FCHVs). Further, extra insurance benefits of NPR 100,00 is given to Cancer, Heart Disease, Kidney Disease, Head Injury, Spinal Injury, Sickle Cell Anemia, Parkinsonism and Alzheimer Disease. They have initiated to work on these domains by including ultra-poor and FCHVs in the program providing subsidies.
Coming to this stage, the program has gone through various small corrections as recommended by researches conducted by various institutions and individuals and their own support mechanisms. However, huge implementation challenges lie ahead in terms of mandate inclusion of formal sector. In addition to the lower enrollment rate, lower renewal rate (one-fourth didn’t renew their policies) adds a further challenge to program administration as they target to enroll two-third population by 2025 and race to full coverage by 2030.There may be multiple factors associated with program management, consumers, service providers or even policy level that hinder the insurance programs from expanding the coverage. Some of the factors may barriers to entrance, quality of service, improper management, not enough service point, or anything. Nothing can be said for sure. In this regard, one important thing comes to mind is what is happening to consumer side? Is the aforementioned problems due to something on demand side? Are they satisfied with the services provided? What are their psycho-demographics regarding the program? These questions can’t be answered straightly.
Evidence suggest that likelihood of enrolling and continuing health insurance scheme is associated with quality of services. Clients/customer/insure satisfaction is an importance tracer of health sector performance and quality of health care. Hence, there is need of a robust research to identify the factors that motivate the public join the insurance and continue the insurance scheme, insure satisfaction, awareness of health insurance and identify other factors so that interventions with proper strategies to achieve targets of full coverage or say Universal Health Coverage by 2030. In this regard, Strengthening Health Insurance Support Program from KOICA wants to conduct such research to address ongoing and upcoming challenges in order to support and strengthen the National Health Insurance Program of Nepal.
KOICA – National Health Insurance Support Program
• To examine public awareness level and satisfaction status of insuree in NHIP.
• To explore reasons for addressing regional disparities in NHIP enrollment/renewal rates and suggest ways for resolving the issues.
• To suggest research findings to complement the existing policy.