Healthcare provider's experience and attitude towards the national health insurance program of Nepal
DOI:
https://doi.org/10.62992/12v77d69Keywords:
Healthcare Provider, Experience, Attitude, National Health Insurance Program, Universal Health CoverageAbstract
Background: Universal Health Coverage (UHC) aims for accessible quality healthcare for all, without financial strain. Nepal's National Health Insurance Program (NHIP), launched in 2016, strives towards this goal by offering extensive healthcare services and financial protection against severe health costs. However, the NHIP encounters challenges, particularly with reimbursement processes and operational efficiency, which may impact its effectiveness and long-term viability.
Objectives: This study analyzed the situation regarding the experience, attitude, and recommendations of government and non-government Health Care Providers (HCPs) regarding the NHIP.
Methods: This Qualitative study carried out a qualitative analysis via in-depth interviews with 12 HCPs across three Nepalese provinces, assessing their experiences with the NHIP. Our method involved a culturally validated interview guide with 21 detailed questions. Interviews, conducted in Nepali, were translated and analysed through open coding to highlight key themes related to the NHIP's effectiveness and challenges.
Results: Aiming to assess the NHIP's service delivery impact, this study selected participants involved in the NHIP and analysed interview data to uncover themes concerning the NHIP's benefit package, the Insurance Management Information System (IMIS), coordination, and claim and reimbursement processes. The study revealed that the healthcare providers recognized the NHIP's benefits in increasing healthcare access and reducing financial burdens in Nepal yet point out limitations in covering complex diseases and financial sustainability for healthcare facilities. Key challenges include technical issues with IMIS and insufficient support from the Health Insurance Board [HIB].
Conclusion: Recommendations for enhancing the NHIP involve speeding up reimbursement, improving IMIS functionality, better coordination with the HIB, and revising the benefit package. Despite progress, significant hurdles in implementation and efficiency persist. Addressing these issues requires a multifaceted approach, including technological upgrades, policy adjustments, and enhanced training for healthcare workers. Optimizing the NHIP is essential for Nepal to achieve its UHC goals, ensuring equitable, accessible, and quality healthcare for all its citizens.
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