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

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.

Impact of Lapsed Policies in Life Insurance Industries of Nepal

Growth and competition are rapidly rising in life insurance sector. Companies have challenge to stay in the market and earn profit as well as build trust among the end users. In this context, companies have to expand business by selling more life insurance policies. However, only selling new policies might not be the solution to increase profit. Thus, company needs to ensure minimum to zero lapse rates for the sustainable growth of the company. This study investigated the impact of lapse rate and revival rate on net worth, profitability, life fund, and total premium income of life insurance industries in Nepal over the period 2010-2019. The study employed Generalized Method of Moments (GMM) for empirical estimation. The empirical results showed the lapse rate, profitability, revival rate and surrender rate of 23.91%, 2.64%, 88.82% and 3.83%, respectively in the life insurance industries in Nepal during the 10 years’ period. The lapse rate was significantly negatively correlated with life fund and the total premium income with the–model coefficients of 0.1474065 and -0.19244, respectively. Moreover, the empirical estimation showed a significant positive correlation between lapse rate and profitability. This might be because high lapse rate lowers the provision of unexpired risk and life fund resulting in higher amount of profitability. The revival rate was significantly positively correlated with the profitability. This might be because higher revival rate increases the renewal income of a company, resulting in more funds available for investment thereby bringing positive cash inflow for the company. However, the revival rate did not show any significant association with net worth, life fund and total premium income.

Factors Associated with Non-Enrollment in National Health Insurance Scheme in Kaski District, Nepal

Health insurance poses a vital role in developing countries, to attain an equitable health outcome to all citizens by ensuring universal health coverage. This study aims to assess the factors associated with non-enrollment in National Health Insurance Scheme (NHIS) in a setting of Nepal. A cross-sectional study was conducted among 492 households (246 non-enrolled and 246 enrolled) of Kaski district, Nepal from May to August 2020. Data were gathered from face-to-face interview. Data were entered in Epi data 3.1 and analysed by using statistical package for social sciences (SPSS16). Descriptive and inferential statistics were performed to analyze the data. The household without elderly family members were 2.06 times less likely to enroll in the scheme (AOR=2.060, CI=1.141-3.721, p<0.01). Similarly, non-enrollment increases with the decreasing wealth quintile of the family (AOR=4.312, CI=1.881-9.880, p<0.001). Families who perceived their family health status as fair was more likely to join the scheme than those as a good health status. Households who had poor or average knowledge on the scheme were almost five times more likely to non-enrollment (AOR=4.641, CI=2.841-7.582, p <0.001). Factors that determine the non-enrolment in NHIS are households had without elderly family members, poor wealth quintile, self-perceived good health status and poor knowledge on NHIS. Effective coordination from different stakeholders need to increase the health insurance coverage and increase the health literacy through the wide coverage of health communication program.

Role of Informal Education, and Human-Agent on Insurance Industry

This article discusses how the insured persons learn to be responsible for managing the risk via insurance and the role of agents in this process. So that, a dozen of purposively selected persons were interviewed with unstructured and open-ended questions. Interpretation of so generated qualitative information suggests that people rarely appreciate insurance, and agents are as dominant as the product in buying decisions. Employing informal education to make citizens responsible for their risk management is almost ineffective. The role of agents in enabling customers as prudent risk managers by raising their awareness about different insurance products is observed as a conflict of interests between the state and the agent. In a liberal society, persuading people by a profit-making company is dominant than the state-delivered awareness program. These findings not only question the role of the insurance agent, a human resource for facilitating people to learn about insurance, as commission-based workers instead of professional but also problematize the legitimacy of transferring the state's responsibility of educating citizens to the private companies.

Editorial Note Vol.3

The first issue of Journal of Insurance and Social Security (NJISS) was published in 2018, second issue in 2019 and the third issue is in your hand. The Editorial Board expresses words of gratitude to all authors, reviewers, advisors and readers for their valuable contribution. In coming days too, we expect such invaluable support and encouragement from our valued personalities so that we will be able to publish the journal frequently maintaining standard of the journal with the international repute. The third issue has incorporated six articles that have been selected out of the dozens of manuscripts. We state the words of gratefulness to all the contributors who showed affection and trust over the NJISS and sent these papers. The Editorial Board requests to all prospective contributors to upload their manuscripts following the general guidelines of the journal. Current issue is also known as social health insurance issue since out of six articles, four are related to government run health insurance schemes while one is related to life insurance lapse and another one is related to insurance education. Nepalese insurance industry can be divided under four segments: privately owned companies run commercial insurance, Social Security fund led social insurance, health insurance board led social health insurance and deposit and credit guarantee fund. The articles published in this issue cover the topics under the commercial insurance and social health insurance. The journal always welcomes the critical review papers on up-to-date subjects on any of the topics in the area of risk, insurance, social security, microfinance, pension, annuity and the related disciplines. Prof. Fatta Bahadur KCEditor-in- ChiefNJISS

Public Service Announcements for Health Insurance in Nepal: Perspectives from Health Belief Model

Public Service Announcement (PSA) is an advertisement to inform the people sponsored by the public company or the governmental agencies. There were several PSAs implemented to inform the people about health insurance (HI). Data from the Health Insurance Board showed low enrolment with high dropout in health insurance programme (HIP). It was found that the PSAs could not attract the people. Therefore, we assessed the PSAs used for the HIP and amomg them, three Radio/FM jingles, eight TV spots, hoarding board, newspapers, and brochure were evaluated using the Health Belief Model (HBM). We found the almost all PSAs have not covered the constructs of HBM. Most of the PSAs have included primarily perceived benefits and perceived susceptibility but missed to include perceived severity, perceived threats, and self-efficacy. Only benefits focused message could not attract the people. Therefore, we recommend that all PSAs need to have all the features of HBM in the PSA messages while notifying and informing the people.

Satisfaction among the Insured and the Uninsured Patients visiting for OPD services in various health facilities of Kaski

Health insurance is the process of financial protection against health-related poverty and catastrophic health care cost. Satisfaction of the patients is the perception towards services they get from the health institution. This study aims to assess the satisfaction level and factors associated with it among the insured and the uninsured patients visiting the OPD services in the health facilities of Kaski. Cross-sectional analytical study was conducted using purposive sampling technique. Data was collected through Face-to-face interview among 258 participants (107 Insured and 151 Uninsured) while EPI DATA and SPSS were used for the data entry and analysis respectively. Ethical approval was obtained from the institutional review committee of Pokhara University and respective health facilities and consent from each participant was taken. Insured and uninsured participants were 41.5% and 58.5% respectively. 52.3% of insured and 49% of uninsured patients were female. Among the 107 insured participants, 74.8% participants visited for the first time and 18.7% for follow up. Educational status and SHI premium affordability were associated with satisfaction of the insured. Waiting time was associated with satisfaction among the uninsured participants. Waiting time, time provided doctors related availability of medicines related to lower level of satisfaction in both participants. Majority of the insured (83.2%) and uninsured (84.8%) participants were satisfied. The study shows overall satisfaction to be good in both insured and uninsured participants; however, it is suggested to improve the health service-related factors like waiting time; time provided by the doctors and the awareness on policy among the patients for further improvement of the program in Nepalese context.

Relationship between trading volume, stock return and return volatility: A case of Nepalese insurance companies

This study examines the factors affecting the share price of Nepalese non-life insurance companies. The knowledge of the factors and their possible impact on share prices is highly appreciable as it would help investors make wise investment decisions and enable firms to enhance their market value. This study is based on secondary data of 15 non-life insurance companies which are listed in Nepal stock exchange. The study covers seven years period from the fiscal year 2011/12 to 2017/18. The result shows that firm size is positively related to market price of share and price earnings ratio. It indicates that larger firm size leads to increase in market price of share and price earnings ratio. However, the study shows that inflation is negatively related to market price of share and price earnings ratio. The study also shows that dividend per share and return on assets are negatively related to the market price of share and price earnings ratio. Similarly, earnings per share have negative relationship with market price of share and price earnings ratio. The study concludes that the increase in return on assets and earnings per shares do not explain the variation in stock price in Nepalese non-life insurance companies. Nepal is one of the emerging economy; the determinants identified may provide knowledge to the potential investors about the key factors affecting share prices in the country and accordingly assist them in optimizing their investment strategy.

Editorial Note Vol.2

No Abstract Available.

Using Expected Geometric Values to Calculate the Cost of Interest in Hyper-inflationary Environments: the Case of Venezuela

It is of vital importance to explore the relationship between pensions and inflationary levels because this forms a link between social policy and economic development in the context of Venezuela’s challenging economy and its impact on the development of pension systems. With such rampant inflation, companies must adjust the rates of salary increases to avoid a significant decrease in the purchasing power of income from defined benefit plans. Our research seeks to find the possibility of using an average geometric rate of future interest rates expressed as an expected value to discount obligations. Consequently, the cost of interest associated with the actuarial liability of the Benefit plans increases substantially in the next fiscal period to the actuarial valuation, sometimes compromising its sustainability over time. In order to minimize this problem, two scenarios for calculating the interest rate are proposed to smooth out this volatile effect; both are based on a geometric average with the expectation of working life or with the duration of the obligations. We are careful to use a reasonable interest rate that is not so high as to compromise the cash flow, resulting in skewed annual results of the companies. Our research seeks to find the possibility of using an average geometric rate of future interest rates expressed as an expected value to discount obligations. We formulate and actuarially evaluate two different scenarios, based on job expectations and Macaulay's duration, of the obligations that allow the sustainability of the plan in an environment of extremely high inflation. To illustrate the impact of the basic annual expenditure of the period, the results of an actuarial valuation of an actual Venezuelan company were utilized. Despite some companies adjusting their book reserves increasingly through a geometric progression, the amounts associated with the costs of interest would be huge in any such adjustment pattern. Therefore, we suggest adoption of one of the alternatives described in the research.