Willingness of Community People to Pay for Health Insurance in Nepal

Abstract

Background: 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, His Majesty Government, 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. Methods: The study was done in Lalitpur, Morang and Sunsari Districts. These districts where Lalitpur Medical Insurance Scheme and Social Health Insurance have been implemented were purposively selected for the study. This is a qualitative descriptive study. Total seven Focus Group Discussions were conducted in these districts. Reporting of the various focus group transcriptions were done in an organized way. The transcriptions were verified to check the discrepancy while reporting. The FGD findings were tabulated based on the FGD guidelines and variables. Results: The participants in Lalitpur Medical Insurance Scheme 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. Although, there is limited participation from the general members of the scheme, the scheme has strengthened the local Health Posts and has established the good referral system in the health care system of the district. The participants in the Social Health Insurance 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 able and willing to pay for the scheme. However, they have comments on the quality of the services and benefit packages. The people in the area where the schemes are not implemented are also able and willing to pay for the health care services.

Conclusions: People are willing to pay for the health insurance schemes if it's affordable and quality care is made available. Therefore, the schemes could be implemented in Nepal. The Lalitpur Medical Insurance Scheme is especially appropriate for the primary health care level. Keywords: community-based health insurance; knowledge; participation; quality health care; satisfaction; schemes; willing to pay.