Willingness of community people to pay for health insurance in Nepal

Abstract

Nepal is one of the poorest countries in the world where majority of the people earn less than one US dollar a day. Due to the low income, more than 60% of the household annual income is spent for food and there would be less income left for health care and other needs. However, HMG, Nepal is planning to implement community based health insurance scheme where people are expected to pay for the health services. The key question comes whether or not community people would be willing to pay for it. This study endeavors to find out the willingness of community people to pay for the health insurance. The study was done in Lalitpur, Morang and Sunsari Districts. In Lalitpur District, UMN has implemented the Lalitpur Medical Insurance Scheme and in Morang and Sunsari District BPKIHS has implemented the Social Health Insurance. This study covers willingness as knowledge, satisfaction, participation and ability to pay in the two health insurance schemes. It also covers willingness as ability to pay in the area where the schemes are not implemented. This is a qualitative descriptive study. Total seven Focus Group Discussions were conducted in these districts. In the study the FGD participants in LMIS have good knowledge of the scheme and have high-level of satisfaction to the scheme since the essential health care services are available locally through the scheme. The people in the scheme think that the premium is affordable and are willing to pay for the scheme. They highly recommend that the scheme should be replicated to other rural health institutions. Although, there is limited participation from the general members of the scheme, the scheme has strengthened the local HPs and has established the good referral system in the health care system of the district. The participants in the SHI have good knowledge of the scheme and are generally satisfied with the access to the health care services in the hospital through the scheme. They are ble and willing to pay for the scheme. However, they have comments on the quality of the ervices and benefit packages. There is no real participation from the community in the decision aking process of the scheme. The people in the SHI implemented area have higher expectation on the level of the services and were also willing to pay for it. It may due to the higher socio-economic status of the community. The people in the area where the schemes are not implemented are also able and willing to pay for the health care services. In these areas, the local health institutions are very under utilized and people are paying high expenses for health services outside local health institution. They expressed their willingness to pay if the health care services are available locally. People are willing to pay for the health insurance schemes if its affordable and quality care is made available. Therefore, the schemes could be implemented in Nepal. The LMIS is especially appropriate for the primary health care level.