scholarly journals Dropout Analysis of a National Social Health Insurance Program at Pokhara Metropolitan City, Kaski, Nepal

2021 ◽  
Author(s):  
Prabin Sharma ◽  
Dipendra Kumar Yadav ◽  
Niranjan Shrestha ◽  
Prabesh Ghimire
Keyword(s):  
Health Insurance ◽  
Health Status ◽  
Social Health Insurance ◽  
Good Health ◽  
Social Health ◽  
Factors Associated ◽  
Insurance Program ◽  
Health Insurance Program ◽  
First Contact ◽  
Structured Questionnaire

Background: Nepal’s national social health insurance (SHI) program, which started in 2016, aims to achieve universal health coverage (UHC), but it faces severe challenges in achieving adequate population coverage. By 2018, enrolment and dropout rates for the scheme were 9 percent and 38 percent respectively. Despite government's efforts, retaining the members in SHI scheme remains a significant challenge. The current study therefore aimed to assess the factors associated with social health insurance program dropout in Pokhara, Nepal. Methods: A cross-sectional household survey of 355 households enrolled for at least one year in the national social health insurance program was conducted. A structured questionnaire was used to conduct face-to-face interviews with household heads were conducted using a structured questionnaire. Data was entered in Epi-Data and analysed using SPSS. The factors associated with social health insurance program dropout were identified using bivariate and multiple logistic regression analyses. Results: The findings of the study revealed a dropout prevalence of 28.2% (95% confidence interval: 23.6%-33.2%). Households having more than five members [adjusted odds ratio (aOR) 2.19, 95% CI: 1.22-3.94], belonging to underprivileged ethnic groups (Dalit/Janajati) (aOR 2.36, 95% CI: 1.08-5.17), living on rented homes (aOR: 4.53, 95%CI 1.87-10.95), absence of chronic illness in family (aOR 1.95, 95%CI: 1.07-3.59), perceived good health status of the family (aOR 4.21, 95%CI: 1.21-14.65), having private health facility as first contact point (aOR 3.75, 95%CI: 1.93-7.27), poor availability of drugs (aOR 4.75, 95%CI: 1.19-18.95) and perceived unfriendly behaviour of service providers (aOR 3.09, 95%CI: 1.01- 9.49) were statistically significant factors associated with SHI dropout. Conclusion: In Pokhara, more than one-fourth of households have dropped out of the Social Health Insurance Scheme, which is a significant number. Dropping out of SHI is most commonly associated with a lack of drugs, followed by rental housing, family members’ reported good health status and unfriendly service provider behaviour. Efforts to reduce SHI dropout must focus on addressing drugs availability issues and improving providers’ behaviour towards scheme holders. Increasing insurance awareness, including provisions to change first contact points, may help to reduce dropouts among rented households, which make up a sizable proportion of the Pokhara metropolitan area.

scholarly journals Factors Affecting Enrollment in Government Health Insurance Program in Kailali District

2019 ◽  
Vol 17 (3) ◽  
pp. 388-393
Author(s):  
Deepak Raj Paudel
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Chronic Illness ◽  
Social Health Insurance ◽  
Social Health ◽  
Factors Affecting ◽  
Government Health ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Insurance Enrollment

Background: Health care financial burden on households is high in Nepal. High health care expenditure is a major obstacle in achieving universal health coverage. The health insurance is expected to reduce healthcare expenditure. However, only small segments of the population are covered by health insurance in Nepal.This study assessed the factors affecting enrollment in government health insurance program in the first piloted district, Kailali, Nepal.Methods: A cross-sectional survey was conducted among 1048 households located in 26 wards of Kailali district after 21 months of the implementation of social health insurance program, Nepal. The sample was selected in two stages, first stage being the selection of wards and second, being the households.Results: The higher level of household economic status was associated with increased odds of enrollment in health insurance program (ORs=4.99, 5.04, 5.13, 8.05, for second, third, fourth, and the highest quintile of households, respectively). A higher level of head’s education was associated with increased odds of health insurance enrollment (ORs = 1.58, 1.78, 2.36, for primary, secondary, tertiary education, respectively). Presence of chronic illness in the household was positively associated with increased odds of health insurance enrollment (OR= 1.29). Conclusions: The poor and low educated groups were less benefited by social health insurance program in Kailali district, Nepal. Hence, policymakers should focus to implement income-based premium scheme for ensuring equal access to healthcare.Since household with chronic illness leads to high odds of being enrolled, a compulsory health insurance scheme can make the program financially sustainable.Keywords: Enrollment; health expenditure; health insurance; inequality; Nepal.

IDENTIFIKASI PERMASALAHAN FINANSIAL PADA JAMINAN SOSIAL KESEHATAN NASIONAL

INFO ARTHA ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. 111-119 ◽  
Author(s):  
Mas'udin Mas'udin
Keyword(s):  
Health Insurance ◽  
Financial Distress ◽  
Social Health Insurance ◽  
Social Health ◽  
Z Score ◽  
Financial Problem ◽  
Health Security ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Score Model

The national social health security program (JKN) is a government program that aims to provide social insurance of health care for all Indonesian people. Within three years of implementation, the JKN program has provided many benefits to the community. However, there is a financial problem indicated by the financial statements of social health insurance program, which is estimated experiencing financial distress. This study aims to identify financial problem of social health insurance program. The research used mix method that is quantitative and qualitative method with sequence explanatory design. Data is taken from Healthcare and Social Security Agency (BPJS) financial statement year 2014 - 2016, and analyzed using Altman (Z-Score) model and Zmijewski (X-Score) model. The result of the study shows that the social health security program has financial distress. Program jaminan kesehatan nasional (JKN) merupakan program Pemerintah yang bertujuan memberikan kepastian jaminan kesehatan yang menyeluruh bagi seluruh rakyat Indonesia. Dalam tiga tahun pelaksanaannya, program JKN telah memberikan banyak manfaat bagi masyarakat. Namun laporan keuangan program jaminan sosial kesehatan menunjukkan adanya permasalahan finansial, yang diduga mengalami financial distress. Penelitian ini bertujuan untuk mengidentifikasi permasalahan finansial program jaminan sosial kesehatan. Metode penelitian yang digunakan mix method, yaitu kuantitatif dan kualitatif dengan desain urutan pembuktian (sequential explanatory). Data bersumber dari laporan keuangan BPJS Kesehatan tahun 2014 s.d 2016, dan dianalisis menggunakan model Altman (Z-Score) dan model Zmijewski (X-Score). Hasil studi menunjukkan bahwa Program Jaminan Sosial Kesehatan mengalami financial distress.

scholarly journals Determinants of Self-Reported Illness: An Experience from Social Health Insurance Program in Nepal

2020 ◽  
Vol 3 (3) ◽  
pp. 1-22
Author(s):  
Deepak Raj Paudel
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Health Insurance ◽  
Logistic Regression Analysis ◽  
Economic Status ◽  
Social Health Insurance ◽  
Social Health ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Household Members

Even though the ultimate goal of social health insurance program is to increase the utilization of health services and reduce the health care expenditure, individuals in developing countries generally do not visit a healthcare provider or spend on healthcare unless they perceive themselves as ill.  Thus, the determinants of such illness reporting could have practical significance in a setting, where the social health insurance program was first being implemented in Nepal. Philosophically, this study follows a post-positivism or empiricism research paradigm. The ontological assumption of this study is a singular reality and regarding the epistemological assumption, this study considers an objective reality, a deductive method of quantitative inquiry. A cross-sectional survey was performed among 6480 individuals from 1048 households located in 26 wards of Kailali district after twenty-one months of the implementation of health insurance program in Nepal. The sample was selected in two stages, first being the selection of wards and second being the households. Data analyses were mainly based on chi-square test and logistic regression analysis. The study revealed that out of total 6480 surveyed individuals, 1590 (24.5%) individuals reported illness and the most commonly self-reported illness was cold/cough/fever in the month prior to the survey. The logistic regression analysis revealed that a number of socioeconomic factors such as health insurance coverage, gender, education level, economic status and employment status are significant predictors of illness reporting. Being insured, household members were more likely to report illness compared to their counterparts (Odds ratio= 1.40, 95% Confidence Interval=1.24-1.59). Females were more likely to report illness compared to males. Members with secondary level of education were significantly less likely to have illnesses than the members with no formal education. Household members from higher household economic status and employed were significantly less likely to have an illness. The findings from this study could inform policy in the ongoing national health insurance debate in Nepal and elsewhere. Since individuals having health insurance are more likely to report illness compared to uninsured, there is need to expand the health insurance program thought the country. Despite some methodological constraints, this study delivers new information on the occurrences of self-reported illnesses among the Nepalese population. This can help policy makers to formulate proper interventions to protect the poor from the financial burden associated with poor-health.

scholarly journals Perception of Social Health Insurance Program among Community People in Pokhara, Nepal

2020 ◽  
Vol 9 (1) ◽  
pp. 211-220
Author(s):  
Sharada Sharma ◽  
Sobita Banjara
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Peer Pressure ◽  
Social Health ◽  
Future Price ◽  
Related Factors ◽  
Provider Attitude ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Community People

Perception of social health insurance program is the way in which it is understood or interpreted in terms of different factors; quality of care service delivery adequacy, benefits of program, convenience, price, providers attitude, peer pressure, Community beliefs and attitudes. The main aim of this study is to identify community people’s perception and the factors influencing the perception of people towards social health insurance program. Data from total of 105household registered in insurance program (insured) were collected. Descriptive cross sectional study design was used. The data were analyzed and interpreted by using descriptive and inferential statistics through the computer program SPSS 16 version and presented in tables. Findings revealed that age group range from 20 to 77 years, 72.4 percent family size 5 or below 74.3 percent utilized the insurance services from the accredited health facility. Regarding the reason for enrollment, 83.8 percent said financial protection against illness, 50.8 percent gave the reason that they had to buy drugs outside facility as the main reason for not renewing the program in future. Price of program related response was top perceived factor with mean 3.97±0.70 whereas provider attitude was low perceived factor with mean 1.95± 0.58. The study concluded that the price of program related factors were the top perceived factors whereas provider attitude related factors were low perceived factors that may influence for the perception of community people towards social health insurance program.

scholarly journals IMPLEMENTATION PROGRAME EVALUATION OF SOCIAL HEALTH SERVICE IN HEALTH INSURANCE BY FAMILY DOCTOR IN PONTIANAK

2018 ◽  
Vol 2 (1) ◽  
pp. 40-47
Author(s):  
Imran Imran
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Family Doctor ◽  
Social Health Insurance ◽  
Product Evaluation ◽  
Social Health ◽  
Service Program ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Health Level

The purpose of the research was to evaluate the implementation of health service process, participant of social health insurance by family doctor, that consist of necessary, the background of the program, readiness of the program, realization of the program and the accomplishment of the health service program in health insurance by family doctor. The research used qualitative and quantitative approach by CIPP (Context, Input, Process, Product) evaluation model. The participants of social health insurance program by family doctor were 10.487 people. Most of them gave positive response and the satisfaction index of health service by family doctor was good. The result of the research showed the implementation of health service in health insurance by family doctor have done with the appropriate purpose and standard. The result of this evaluation research was the health service in health insurance program by family doctor could increase the participants of health insurance’s health level in Pontianak City and it can be continued by The Social Health Insurance Provider.   Keywords: Social health insurance, family doctor, health service program, health level.

scholarly journals Urban Self-employed Social Health Insurance Program as an Option in Financing Health Care within the Informal Sector? An Insight into the Acceptability of the Scheme by the Self-employed in Rivers State, Nigeria

2019 ◽  
pp. 1-9
Author(s):  
Ikeokwu E. Anderson ◽  
Foluke O. Adeniji
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Social Health Insurance ◽  
Health Insurance Scheme ◽  
The Self ◽  
Social Health ◽  
Insurance Scheme ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Rivers State

Introduction: Health care financing in the Nigerian health sector has been a major impediment within the sector due to increasing healthcare costs. Various forms of financing mechanisms are employed within the country with majority tilting to out-of-pocket payment, which led to the launch of the National Health Insurance Scheme in 2005. The National Health Insurance Scheme has the ambition to provide universal coverage to the population in 15-20 years, but the scheme had its limitations in achieving universal health coverage because it is limited to federal government civil servants neglecting the informal sector, which includes self-employed individuals. Although other forms of social health insurance scheme are being implemented within the country such as the Community Based Health Insurance Scheme. There is no sufficient evidence on the actualization of a health insurance program specifically for the self-employed despite its presence in the health insurance package known as Urban Self-Employed Social Health Insurance Program. This study aims to ascertain the perceived impact and acceptability of the Urban Self-employed Social Health Insurance Program as a viable option in financing healthcare among the self-employed. Methodology: This was a cross-sectional descriptive study of 204 self-employed individuals who were selected from seven different trade associations in Port Harcourt using semi-structured interviewer-administered pre-tested questionnaires. A Socio-Economic Status index was used to divide the households into quintile. The respondents rated their perception about the possible benefits of health insurance from 1 (none) to 4 (high) and the willingness of respondents to enrol in a community-based health insurance scheme (elicited as a binary ‘yes’ or ‘no’ variable) was also used as a proxy of acceptability data collected were analysed using the statistical package for social science (SPSS), version 23 software. Result: A majority 201 (98.5%) of the respondents perceived that having any form of insurance has the potential to improve access to health care and affordable. Respondents gave responses rated with an average mean of 3, which translates to medium impact on financial protection, improved access to healthcare, affordability and improving quality of treatment. Most respondents 183 (89.7%) accepted the urban self-employed health insurance scheme as a strategy for financing healthcare. Conclusion: Urban Self-Employed Social Health Insurance Program appears to be a viable and acceptable method of paying for healthcare among the self-employed in Port Harcourt city of Rivers State, Nigeria.

scholarly journals IMPLEMENTATION PROGRAME EVALUATION OF SOCIAL HEALTH SERVICE IN HEALTH INSURANCE BY FAMILY DOCTOR IN PONTIANAK

2018 ◽  
Vol 2 (1) ◽  
pp. 40-47
Author(s):  
Imran Imran
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Family Doctor ◽  
Social Health Insurance ◽  
Product Evaluation ◽  
Social Health ◽  
Service Program ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Health Level

The purpose of the research was to evaluate the implementation of health service process, participant of social health insurance by family doctor, that consist of necessary, the background of the program, readiness of the program, realization of the program and the accomplishment of the health service program in health insurance by family doctor. The research used qualitative and quantitative approach by CIPP (Context, Input, Process, Product) evaluation model. The participants of social health insurance program by family doctor were 10.487 people. Most of them gave positive response and the satisfaction index of health service by family doctor was good. The result of the research showed the implementation of health service in health insurance by family doctor have done with the appropriate purpose and standard. The result of this evaluation research was the health service in health insurance program by family doctor could increase the participants of health insurance’s health level in Pontianak City and it can be continued by The Social Health Insurance Provider.   Keywords: Social health insurance, family doctor, health service program, health level.

Willingness of in-patients to uptake the vital contributor social health insurance program in a teaching hospital, Southwest Nigeria

2020 ◽  
Vol 29 (3) ◽  
pp. 476
Author(s):  
OluwaseunT. Esan ◽  
KehindeO. Falayi ◽  
BolurinA. Adekunle ◽  
Temitope Akinwunmi ◽  
OyetadeO. Ajao ◽  
...  
Keyword(s):  
Health Insurance ◽  
Teaching Hospital ◽  
Social Health Insurance ◽  
Social Health ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Southwest Nigeria
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