Preprint Article Version 1 NOT YET PEER-REVIEWED

Effectiveness of Public and Co-operative Health Insurance Models in Nepal: A Concurrent Mixed Study

  1. Department of Preventive Medicine, Wonju College of Medicine Yonsei University, Wonju, Gangwon 220-701, Korea
  2. Health Science Foundations and Study Center, Kathmandu, Nepal
  3. Institute for Poverty Alleviation and International Development, Yonsei University Wonju, Gangwon 220-710, Korea
Version 1 : Received: 6 August 2016 / Approved: 6 August 2016 / Online: 6 August 2016 (11:54:03 CEST)

How to cite: Ranabhat, C.; Kim, C.; Park, M. Effectiveness of Public and Co-operative Health Insurance Models in Nepal: A Concurrent Mixed Study. Preprints 2016, 2016080068 (doi: 10.20944/preprints201608.0068.v1). Ranabhat, C.; Kim, C.; Park, M. Effectiveness of Public and Co-operative Health Insurance Models in Nepal: A Concurrent Mixed Study. Preprints 2016, 2016080068 (doi: 10.20944/preprints201608.0068.v1).

Abstract

Background: Health insurance (HI) run by government is providing health care service to large population. Due to poor accountability, participation and sustainability, cooperative health insurance is becoming more popular and effective in low and middle income and some high-income countries too. In Nepal, there are public and cooperative HI is in practice. The aim of this study is to compare the effectiveness of public (government) and cooperative HI in relation to benefit packages, population coverage, inclusiveness, health care utilization, and promptness for treatment in these two health insurance models in Nepal. Method: This is an institution based concurrent mixed study consists of qualitative and quantitative variables from public and cooperative groups. We included all public HI operated by government hospitals and cooperatives groups those purchased hospital service in contract. Two separate study tools were applied to access the effectiveness of insurance models. The key questions were asked for the representatives of government and private health insurance. The numeric information consisted of in quantitative data and subjective response was included in qualitative approach. Descriptive statistics and Mean Whitney U test was applied in numeric data and qualitative information were analyzed by inductive approach Results: The study revealed that new enrolment was not increased, health care utilization rate was increased and the benefit package was almost same in both groups. The overall inclusiveness was higher for the government HI, but enrolment from the religious minority, proportion of negotiated amount during treatment were significantly higher (p<0.05). During illness, the response time to reach hospital was significantly faster in cooperative health insurance than government health insurance. Qualitative findings showed that level of participation, accountability, transparency and recording system was better in cooperative health insurance than public. Conclusion: Cooperative HI could be more sustainable and accountable to the community for all; low, middle and high-income countries.

Subject Areas

community-based health insurance; cooperative; benefit package; social inclusion; healthcare; Nepal

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