Perception of dropped outs insurees towards government’s health insurance programme in Lumbini Province, Nepal.

Research Report.

ABSTRACT:

Nepal's health insurance programme (HIP) is in the implementation phase which is
operated and regulated by Health Insurance Board (HIB): a government-funded organization.
The HIP has covered almost all districts but the enrolment rate seems low while the drop-out
rate appears high that threatened the sustainability of the programme. Limited studies have
been conducted to explore the causes of drop-out of the HIP. The study aimed to explore the
causes of drop-out of the HIP. The study used a qualitative research design from the
perspective of interpretivism. Data were collected from 16 in-depth interviews, 4 key
informant interviews, and 4 focus group discussions from Palpa and Bardia in Lumbini
Province from 2nd December 2021 to 17th February 2022. Thematic analysis was performed
to analyse the qualitative data. We identified 9 drop-out related themes that were further
categorized into three major factors. Drop-out related to demand side factors, supply side
factors, and policy related factors were identified. Major causes of drop-out were identified as
a lengthy process, poor quality services, inadequate information about health insurance, and
health workers' behaviour towards the insured person. Health Insurance related information,
education, and communication programme is still required to minimize the problems.
Policymakers could consider these factors into account while planning the interventions. A
mixed or multi-methods approach could be done for a better understanding of drop-out and
retention of the HIP in the context of Nepal.