Utilization of social health security scheme among the households of Illam district, Nepal.

Thesis Report.

ABSTRACT:

Introduction: Health insurance is one of the methods of health care financing. Types of health insurance are social health insurance, private health insurance and community-based-health insurance. Nepal has implemented Social health insurance program which is also known as Social Health Security program (SHS) to ensure access to quality health services and to protect from financial hardship and reduce out-of-pocket payments. The study aims to assess the utilization pattern of social health security scheme among the households of Illam district.

Methodology: A cross-sectional mixed method study was conducted among the three hundred households of Illam district who has utilized the social health security scheme. Multi-stage sampling method was used. Both quantitative and qualitative methods were done during the study. A semi-structured questionnaire was used to collect quantitative data. For qualitative data focus group discussion was conducted using focus group discussion guidelines. Descriptive analysis, bivariate and multivariate analysis was done. FGDs were transcribed and thematic analysis was done.

Results: The utilization rate of social health security scheme was 88.7%. The utilization rate of receiving drugs, Out-Patient service, Laboratory service, In- patient service and Emergency service were 96.2%, 89.4%, 67.7% 10.4% and 0.4% respectively. Only 13% of households had to go for catastrophic health expenditure. Presence of under five children and chronic illness in households, sex, age group, educational status, occupation of household members were significantly associated with the utilization of social health security scheme. A total of three FGDs were conducted. It revealed that people were aware of social health insurance and satisfied with program implemented by government. However, the hospitals under the social health insurance were not able to meet their expectation. Moreover, unavailability of service in hospital and poor behavior by hospital staff had developed negativity among people.

Conclusion: Although the utilization of social health security scheme was higher, people were unsatisfied with the service and facility provided by the hospital under the social health security scheme. Therefore, the social health insurance board should closely monitor the hospitals and develop a feedback mechanism from the users.

Keywords: Social Health Insurance, Utilization of Service, Catastrophic Health Expenditure