| Peer-Reviewed

Social Health Insurance and Its Role in Catastrophic Health Expenditure: A Cross-Sectional Study in Illam District, Nepal

Received: 16 July 2022     Accepted: 1 August 2022     Published: 10 August 2022
Views:       Downloads:
Abstract

Nepal remains committed to achieving universal health coverage, to ensure that government introduced social health insurance program in Illam district with objective that everyone should get health services they need and in doing so they should not go under the financial hardship. The study aims to assess the achievement of the program objective by determining the catastrophic health expenditure. A cross-sectional study was conducted in Illam district of Nepal, among 300 insured households whose date of service had come into effect. Face to face interview was done to collect the data using pretested semi-structured questionnaire with the sample selected through multi-stage random sampling technique. Binary logistic regression analysis was used to identify the factors associated with catastrophic health expenditure. The prevalence of catastrophic health expenditure was 13.2%. Additionally, univariate analysis showed household income and saving were mostly used for coping with out-of-pocket health payment while multivariate analysis revealed that No. of working Member in household, Presence of Under five children, Presence of chronic illness, Poverty line of household were significant factors associated with catastrophic health expenditure. Despite of the high utilization, social health insurance has not reduced the catastrophic health expenditure however, it has contained it. Thus, to further decrease the financial hardship, government needs to redesign the benefit package with wider scope and control the provider side moral hazard.

Published in International Journal of Health Economics and Policy (Volume 7, Issue 3)
DOI 10.11648/j.hep.20220703.14
Page(s) 65-70
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Social Health Insurance, Catastrophic Health Expenditure, Illam, Nepal

References
[1] Toolkit on monitoring health systems strengthening: HEALTH SYSTEMS FINANCING. Geneva: World Health Organization; 2008. 1-14.
[2] Technical Brief for Policy-Maker: Achieving Universal Health Coverage: Developing The Health Financing System. Geneva: World Health Organization Department of Health System Financing Health Financing Policy; 2005. 1-9.
[3] Philip NE, Kannan S, Sharma SP. Utilization of Comprehensive Health Insurance Scheme, Kerala: A Comparative Study of Insured and Uninsured Below-Poverty-Line Households. Asia-Pacific Journal of Public Health 2016; 28: 77-85.
[4] Social Health Security Program: Standard Operating Procedure. Kathmandu: Government of Nepal Social Health Security Development Committee; 2016. 1-98.
[5] Preker A et al. Rich-poor differences in health care financing. In: Preker A, Carrin G, eds. Health financing for poor people: resource mobilization and risk-sharing. Washington, DC: The World Bank; 2004. 1-50.
[6] Gottret P, Schieber G. Health Financing Revisited: A Practitioner’ Guide. Washington, DC: The World Bank; 2006. 1-324.
[7] The World Health Report: Health Systems Financing: The path to universal coverage. Geneva: World Health Organization; 2010. 1-128.
[8] Mahato PK, Paudel GS. Access to free health-care services for the poor in tertiary hospitals of western Nepal: a descriptive study. WHO South-East Asia Journal of Public Health 2015; 4 (2): 167-75.
[9] https://knoema.com/atlas/Nepal/topics/Health/Health-Expenditure/Out-of-pocket- [cited on 3rd Mar 2018].
[10] Nepal National Health Accounts 2009/10 - 2011/12. Kathmandu: Government of Nepal Ministry of Health Human Resource and Financial Management Division Health Financing Unit; 2016. 1-94.
[11] Review of Social Health Insurance Scheme in Selected Districts of Nepal; 2017 [cited on 28 Mar 2018]. Available from: http://nhrc.gov.np/projects/review-of-social-health-insurance-scheme-in-selected-districts-of-nepal/
[12] Xu K. & World Health Organization. Dept. of Health System Financing and Cluster Evidence and Information for Policy: Distribution of health payments and catastrophic Methodology. DISCUSSION PAPER NUMBER 2; 2005. 1-10.
[13] Li Y, et al. Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?. PLoS ONE 2014; 9: 1-9.
[14] Brinda EM, Andres RA, Enemark U. Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey. BMC International Health & Human Rights 2014; 14: 1-8.
[15] Nandi S, Schneider H, Dixit P. Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage. PLoS ONE 2017; 12: 1-18.
[16] Scheil-Adlung X. et al. & World Health Organization. Dept. Department "Health System Financing and Cluster Evidence and Information for Policy: What is the impact of social health protection on access to health care, health expenditure and impoverishment? A comparative analysis of three African countries. DISCUSSION PAPER NUMBER 2; 2006. 1-26.
[17] Castillo-Laborde C, et al. Health Insurance Scheme Performance and Effects on Health and Health Inequalities in Chile. MEDICC Review 2017; 19: 57-64.
[18] Saito E, et al. Catastrophic household expenditure on health in Nepal: a cross-sectional survey. Bull World Health Organ 2014; 92: 760–67.
[19] Gupta I, Chowdhary S. Correlates of out-of-pocket spending on health in Nepal: implications for policy. WHO South-East-Asia Journal of Public Health 2014; 3: 238-46.
[20] Thuy k, et al. Social science and medicine coping with health care expenses among poor households: Evidence from a rural commune in Vietnam. Social Science & Medicine 2012; 74 (5): 724-33.
[21] Hoque ME, Dasgupta SK, Naznin E, Mamun A. Household coping strategies for delivery and related health care cost: finding from rural Bangladesh. Trop Med Intel Health 2015; 20 (10): 1368-75.
[22] Arnold M, et al. Coping with the economic burden of diabetes, TB, and co-prevalence: evidence from Bishkek, Kyrgyzstan. BMC Health Service Research 2016; 8: 1-13.
[23] Dhanaraj S. Health Shocks and coping strategies: State insurance scheme of Andhara Pradesh, India.”Wider working paper”. 2014; World Institute for Development Economics Research: 003.
[24] Li Y, et al. Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bull World Health Organ 2012; 90: 664-71.
[25] Azzani M, Roslani AC, Su TT, Determinants of household catastrophic health expenditure: a systematic review. Malays J Med Sci 2019; 6: 15-43.
[26] Health insurance in low-income countries, Joint NGO Briefing Paper; 2008 [cited on 19 February 2019]. Available from: https://d1tn3vj7xz9fdh.cloudfront.net/s3fs-public/file_attachments/bp112_health_insurance_0805_4.pdf
[27] Shah S, Jha N, Khanal VK, Nepal Gurung G, Sharma B, Shrestha M. Utilization of social health security scheme among the households of Illam district, Nepal. PLoS ONE 2022; 17 (5): 1-10.
Cite This Article
  • APA Style

    Sanjeeb Shah, Nilambar Jha, Vijay Kumar Khanal, Gyanu Nepal Gurung, Mausam Shrestha, et al. (2022). Social Health Insurance and Its Role in Catastrophic Health Expenditure: A Cross-Sectional Study in Illam District, Nepal. International Journal of Health Economics and Policy, 7(3), 65-70. https://doi.org/10.11648/j.hep.20220703.14

    Copy | Download

    ACS Style

    Sanjeeb Shah; Nilambar Jha; Vijay Kumar Khanal; Gyanu Nepal Gurung; Mausam Shrestha, et al. Social Health Insurance and Its Role in Catastrophic Health Expenditure: A Cross-Sectional Study in Illam District, Nepal. Int. J. Health Econ. Policy 2022, 7(3), 65-70. doi: 10.11648/j.hep.20220703.14

    Copy | Download

    AMA Style

    Sanjeeb Shah, Nilambar Jha, Vijay Kumar Khanal, Gyanu Nepal Gurung, Mausam Shrestha, et al. Social Health Insurance and Its Role in Catastrophic Health Expenditure: A Cross-Sectional Study in Illam District, Nepal. Int J Health Econ Policy. 2022;7(3):65-70. doi: 10.11648/j.hep.20220703.14

    Copy | Download

  • @article{10.11648/j.hep.20220703.14,
      author = {Sanjeeb Shah and Nilambar Jha and Vijay Kumar Khanal and Gyanu Nepal Gurung and Mausam Shrestha and Bibek Shah},
      title = {Social Health Insurance and Its Role in Catastrophic Health Expenditure: A Cross-Sectional Study in Illam District, Nepal},
      journal = {International Journal of Health Economics and Policy},
      volume = {7},
      number = {3},
      pages = {65-70},
      doi = {10.11648/j.hep.20220703.14},
      url = {https://doi.org/10.11648/j.hep.20220703.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20220703.14},
      abstract = {Nepal remains committed to achieving universal health coverage, to ensure that government introduced social health insurance program in Illam district with objective that everyone should get health services they need and in doing so they should not go under the financial hardship. The study aims to assess the achievement of the program objective by determining the catastrophic health expenditure. A cross-sectional study was conducted in Illam district of Nepal, among 300 insured households whose date of service had come into effect. Face to face interview was done to collect the data using pretested semi-structured questionnaire with the sample selected through multi-stage random sampling technique. Binary logistic regression analysis was used to identify the factors associated with catastrophic health expenditure. The prevalence of catastrophic health expenditure was 13.2%. Additionally, univariate analysis showed household income and saving were mostly used for coping with out-of-pocket health payment while multivariate analysis revealed that No. of working Member in household, Presence of Under five children, Presence of chronic illness, Poverty line of household were significant factors associated with catastrophic health expenditure. Despite of the high utilization, social health insurance has not reduced the catastrophic health expenditure however, it has contained it. Thus, to further decrease the financial hardship, government needs to redesign the benefit package with wider scope and control the provider side moral hazard.},
     year = {2022}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Social Health Insurance and Its Role in Catastrophic Health Expenditure: A Cross-Sectional Study in Illam District, Nepal
    AU  - Sanjeeb Shah
    AU  - Nilambar Jha
    AU  - Vijay Kumar Khanal
    AU  - Gyanu Nepal Gurung
    AU  - Mausam Shrestha
    AU  - Bibek Shah
    Y1  - 2022/08/10
    PY  - 2022
    N1  - https://doi.org/10.11648/j.hep.20220703.14
    DO  - 10.11648/j.hep.20220703.14
    T2  - International Journal of Health Economics and Policy
    JF  - International Journal of Health Economics and Policy
    JO  - International Journal of Health Economics and Policy
    SP  - 65
    EP  - 70
    PB  - Science Publishing Group
    SN  - 2578-9309
    UR  - https://doi.org/10.11648/j.hep.20220703.14
    AB  - Nepal remains committed to achieving universal health coverage, to ensure that government introduced social health insurance program in Illam district with objective that everyone should get health services they need and in doing so they should not go under the financial hardship. The study aims to assess the achievement of the program objective by determining the catastrophic health expenditure. A cross-sectional study was conducted in Illam district of Nepal, among 300 insured households whose date of service had come into effect. Face to face interview was done to collect the data using pretested semi-structured questionnaire with the sample selected through multi-stage random sampling technique. Binary logistic regression analysis was used to identify the factors associated with catastrophic health expenditure. The prevalence of catastrophic health expenditure was 13.2%. Additionally, univariate analysis showed household income and saving were mostly used for coping with out-of-pocket health payment while multivariate analysis revealed that No. of working Member in household, Presence of Under five children, Presence of chronic illness, Poverty line of household were significant factors associated with catastrophic health expenditure. Despite of the high utilization, social health insurance has not reduced the catastrophic health expenditure however, it has contained it. Thus, to further decrease the financial hardship, government needs to redesign the benefit package with wider scope and control the provider side moral hazard.
    VL  - 7
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

  • School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

  • School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

  • School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

  • Karuna Foundation Nepal, Biratnagar, Nepal

  • ICU Department, Chitwan Medical College, Bharatpur, Nepal

  • Sections