A

REPORT

ON

SATISFACTION TOWARDS THE SOCIAL HEALTH INSURANCE

SUBMITTED BY:-

Namrata Adhikari
Pratima Subedi
Pooja Shah
Sun Devi Gurung
Roshni Thapa

Bachelor of Business Administration

Pokhara University
BBA 5th Semester

SUBMITTED TO

Rabindra Ghimire

November 2021
ACKNOWLEDGEMENT
We take this opportunity to express our deepest and sincere gratitude to our
respected teacher, Mr. Rabindra Ghimire, Pokhara University for his insightful
advice, motivating suggestions, invaluable guidance, help and support in preparing
this report and also for his constant encouragement and advice throughout our
research.

Also we would like to convey our thanks to all the participants who participated in
our research and provided us with their invaluable time. Finally, yet more
importantly, we would like to express our deep appreciation to our parents for their
perpetual support and encouragement.

We shall appreciate any suggestions and/or criticism regarding our report.

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ABSTRACT
Social Health Insurance(SHI) is a form of financing and managing health care
based on risk pooling. Social Health insurance pools both the health risks of the
people on one hand, and the contributions of individuals, households, enterprises,
and the government on the other. Thus, it protects people against financial and
health burden and is a relatively fair method of financing health care. In the present
study, 20 to 77 years community people were included. Majority (80 %) of them
were married, 30 percent had secondary level education, 10 percent were
unemployed which includes; seeking work, household work, students, no work, 40
percent were involved in agriculture,60 percent family size was 5 or above.
Majority (65%) answered that financial protection against illness as the main
reason they enrolled whereas only 25 percent include the reason for enrolling as
relative ask me to join. 70 percentage of the people are not satisfied with the health
insurance program.50 percent gave the reason that they had to buy drugs outside
facility as the main reason for not renewing the program in future.

Keywords : insurance, enterprises, finance

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Table of Contents
ACKNOWLEDGEMENT .................................................................................................................................... i
ABSTRACT...................................................................................................................................................... ii
Background ................................................................................................................................................... 1
Objective ....................................................................................................................................................... 3
Data and Methods ........................................................................................................................................ 4
Results ........................................................................................................................................................... 5
Discussion...................................................................................................................................................... 9
Conclusion ................................................................................................................................................... 10
References .................................................................................................................................................. 11
Background
In past decades, Nepal has made notable progress in improving the overall health
status of the population. However, the overall progress in health outcomes masks
the significant equity gap that continues to persist. Many citizens still face several
barriers – financial, socio-cultural, geographical, and institutional – in accessing
quality health care services. Healthcare costs pose a barrier to seeking healthcare,
and can be one of the major causes of indebtedness and impoverishment,
particularly among the poor population. An individual with a low income may be
unable to afford preventive or curative care in different disease condition, which
may result in the worsening of his or her state of health.

Social Health Insurance (SHI) is a form of financing and managing health care
based on risk pooling. Social Health insurance pools both the health risks of the
people on one hand, and the contributions of individuals, households, enterprises,
and the government on the other. Thus, it protects people against financial and
health burden and is a relatively fair method of financing health care. Desirable
though it is, not many least-developed and low-middle-income countries have
succeeded in adequately expanding coverage of SHI. Most countries rely primarily
on tax-funded finance, which is also relatively fair.

Japan and the Republic of Korea are amongst the countries in Asia and the Pacific,
which have universal coverage of SHI, while lower middle income countries like
Thailand and Philippines have a high proportion of SHI coverage. Developing
countries with stronger economies like China, Indonesia, and India have lower
population coverage through SHI schemes. SHI implementation depends on the
level of socio-economic development, financial sector development (mainly
banking) and, employment conditions, especially the existence of a larger
proportion of formal sector organized establishments.

Countries with higher socio-economic status and a high employment ratio tend to
have large SHI coverage. Countries which have reached almost universal coverage
are grappling with cost containment, quality of care, equity issues, regulation, and
policy re-definition. Countries without universal coverage of SHI are trying to
attain substantial population coverage, through mutual health insurance and
community- based schemes. Many of these efforts are frequently hampered by lack

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of national consensus on policy framework, poor regulation and inadequate
administrative capacity.

Social health insurance program was initiated with the objective of ensuring health
services to everyone so as to improve access to and utilization of quality health
care services to all the people of Nepal. This program is expected to play an
important role in achieving sustainable development goals by 2030 by propelling
the country towards universal health coverage (Department of Health Services,
Nepal. 2015/16).

Health care financing in resource-poor country like Nepal relies mostly on

household out of pocket payments (60%) which often results in financial
catastrophe or poverty if services December 2020 Janapriya Journal of
Interdisciplinary Studies 213 Perception of Social Health Insurance Program
among Community People in Pokhara, Nepal are paid for, or welfare loss if the
client is refused access to healthcare due to financial barriers. To address these
challenges, the Government of Nepal implemented social health insurance scheme
since 2016. Demand for health insurance membership cannot be delinked from the
quality of health services which the scheme gives access too. Membership will be
less attractive if services are of poor quality (WHO, 2010).

In India it was observed that the main barriers for the subscription of health
insurance were low income or uncertainty of income, not adequate knowledge
regarding its benefits and do not feel the need (Madhukumar & Gaikwad, 2012).
Literature has shown that insuredpersons have complained of poor attitude and
behavior of service providers operating in the health insurance scheme. Study
conducted in Kenya show that perceived poor quality of care in public health
system can be a major hindrance of Universal Health Coverage. Good quality
services, particularly related to drug availability and interpersonal relationship
between clients and health provider can boost trust in the public system and in so
doing encourage people to belong to health insurance. Understanding the problems
associated with health service provision would help in future implementation
strategies of the scheme by identifying what has happened, and how to progress to
make it better for all. Thus there is a great need to assess the perception about the
health insurance service in community in the context of Nepal.

2
Objective
The main objective of this research is :

• To determine the enrollee's satisfaction with health service provision under a

health insurance scheme and the factors which influence the satisfaction and
dissatisfaction.

3
Data and Methods
Descriptive cross- sectional study design was used to assess perception of social
health insurance program among the people residing in Pokhara Metropolitan city
ward no.5, Parshyang. The nature of the data was quantitative that consist number.
The data was collected from primary source through face-to-face interview with
the respondents. Purposive sampling method was used in this study. Information
about insured people in the Parshyang was obtained from the ward office authority
of ward no. 5 Pokhara Metropolitan city. With the help of key informant; member
of mothers group, researcher was reached to the insured people. Information was
collected from the total of 20 household registered in insurance programs
(insured). Respondents were informed about the purpose of study and methods that
would be used.

They were clearly explained about their voluntary participation in the study and
they were free to refuse to participate in the study at any time. Informed consent
was taken from all the respondents to ensure the right to dignity and explain them
about the study purpose and interviewed in a separate place. The time taken for the
interview was 25 to 30 minutes. Researcher assured that information would be kept
confidential; name of respondents was not attached with the information and was
used for study purpose only. The duration of the data collection was October to
November, 2021. The findings of the study were presented in different tables.

4
Results
In this study analysis and interpretation of data obtained from 20 respondents on
satisfaction on social health insurance. Results of the study organized as
background information, reason for enrolling the insurance program, reason for not
renewing the program in future and influencing factor of health insurance program
and level of satisfaction. Table 1 mainly deals with some important demographic
characteristics such as age, gender, education, occupation, income level, home
ownership and family size of the respondents.

Table 1(Background Information of Respondents)

Variables Number Percentage

Age in years
20-39 5 25
40-59 11 55
60 above 4 20
Gender
Male 12 60
Female 8 40
Marital status
Unmarried 2 10
Married 16 80
Divorce/Widow/Widower 2 10
Educational status
Informal 3 15
Primary 7 35
Secondary 6 30
Higher Education 4 20
Economic activities
Agriculture 8 40
Salary/ Wages 5 25
Own Enterprise 3 15
Unemployed 2 10
Retired 2 10
Size of family
Below 5 8 40
5 or above 5 12 60

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Table 1 shows, age group range from 20 to 77 years. Majority (80 %) of them were
married, 30 percent had secondary level education, 10 percent were unemployed
which includes; seeking work, household work, students, no work, 40 percent were
involved in agriculture,60 percent family size was 5 or above.

Table 2 (Reason for Enrolling the Insurance Program)

Reason for enrolling Number Percentage

Financial protection against illness 13 65
Better then out of pocket 1 5
Community leader ask me to join 1 5
A relative ask me to join 5 25

Table 2 shows the reasons for enrolling the insurance program. Majority (65%)
answered that financial protection against illness as the main reason they enrolled
whereas only 25 percent include the reason for enrolling as relative ask me to join.

Table 3(Satisfied and not satisfied participates)

Satisfaction Number Percentage

Satisfied 6 30
Not satisfied 14 70

Satisfaction
16
14
12
10

8
6
4
2

0
Satisfied Not Satisfied

Satisfaction

Figure 1 Satisfied vs not satisfied

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Table 3 shows 70 percentage of the people are not satisfied with the health
insurance program.

Table 4(Reasons for satisfaction) (n=6)

Reasons Number Percentage

Satisfied with service providers
Satisfied with reception of services
Service providers explanation
about diagnostic tests
Satisfied with drug provides
3 50
1 16.67
1 16.67
1 16.67

Reasons for satisfaction

Satisfied with service providers

19%

Satisfied with reception of services

49%
16% Service providers explanation about
diagnostic tests
Satisfied with drug provides
16%

Figure 2 Reasons for satisfaction

Table 4 shows 50 percent are satisfied with service providers.

Table 5(Reasons for not satisfaction) (n=14)

Reasons Number Percentage

Not satisfied with provider
Difficulty in accessing services
Had to buy drugs outside facility
Was given poor quality care
Others
2 14.28
1 7.14
7 50
3 21.42
1 7.14
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Table 5 shows 50 percent gave the reason that they had to buy drugs outside
facility as the main reason for not renewing the program in future.

Reasons for not satisfaction

7% 14%

Not satisfied with provider

22% 7%
Difficulty in accessing services
Had to buy drugs outside facility
Was given poor quality care
Others

50%

Figure 3 Reasons for dissatisfaction

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Discussion
Social Health Insurance Program was initiated to improve access and utilization of
quality health care services to all the people of Nepal. This program is expected to
play an important role in achieving Sustainable Development Goals towards
Universal Health Coverage. Perception of Social Health Insurance Program is the
way in which it is interpreted in terms of different factors; quality of care, benefits
of program, convenience, price, providers attitude, peer pressure, Community
beliefs and attitudes. In the present study, 20 to 77 years community people were
included. Majority (80 %) of them were married, 30 percent had secondary level
education, 10 percent were unemployed which includes; seeking work, household
work, students, no work, 40 percent were involved in agriculture,60 percent family
size was 5 or above. Majority (65%) answered that financial protection against
illness as the main reason they enrolled whereas only 25 percent include the reason
for enrolling as relative ask me to join. 70 percentage of the people are not satisfied
with the health insurance program.50 percent gave the reason that they had to buy
drugs outside facility as the main reason for not renewing the program in future.

The reason for enrollment was nearly similar to the findings of a previous study
carried out in Ghana by Appiah et al., (2012). Likewise, similar findings were
noted in the study conducted in Saudi Arabia by Mulupi, Kirigia &Chuma (2013).
Present study shows that the main reason for not satisfaction is to buy drugs
outside facility (50). But the findings of a previous study carried out in Ghana by
Appiah et al.,(2012) shows the main reason for not satisfaction or not renewing
was being unable to afford renewal payments. Findings of this study illustrated that
price of program related factor and peer influence related factors were the major
two perceived factor.

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Conclusion
The Social Health Insurance Program is a social protection program of the
Government of Nepal that aims to enable its citizens to access quality health care
services without placing a financial burden on them. The study concluded that
majority of the people are not satisfied with the program. The main reason was that
they had to buy drugs outside facility as the main reason for not renewing the
program in future.Thus the advocacy of the program towards quality health
services and attempts to address barriers in health service utilization, ensure equity
and access of poor and disadvantaged groups as a means to achieve Universal
Health Coverage.

10
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sheets/detail/universal-health-coverage-(uhc)

2. MOHFW Bangladesh National Health Accounts 1997–2015: Preliminary

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