Abstract
Nepal is pursuing Social Health Insurance as a way of mobilizing revenues to achieve Universal Health Coverage. The Social Health Insurance governance encourages service providers to maintain quality and efficiency in services provision by practicing strategic purchasing. Social Health Security Programme is a social protection program which aspires to achieve the goals of Social Health Insurance. Social Health Security Development Committee needs to consider following experiences to function as a strategic purchaser. The Social Health Security Development Committee need to be an independent body instead of falling under Ministry of Health. Similarly, purchasing of health services needs to be made strategic, i.e., Social Health Security Development Committee should use its financial power to guide the provider behavior that will eventually contribute to achieving the goals of quality and efficiency in service provision. The other social health security funds should be merged with Social Health Security Development Committee and develop a single national fund. Finally, the state has to regulate and monitor the performance of the SHI agency.
Highlights
Nepal is pursuing Social Health Insurance (SHI) as a way of mobilizing revenues to achieve Universal Health Coverage (UHC) as integrated within broader National Health Sector Strategy 2015 and Sustainable Development Goals.[1]
Our purpose is to discuss the global experiences and best practices regarding the SHI governance which can be useful in designing SHI, which is in the inception stage in Nepal
Provider, the essential role of SHI governing agency/ purchaser (Figure 1).[3]. To facilitate such a role of the purchaser, several issues have to be addressed such as ownership of the SHI agency; organizational structure; purchasing services; and government supervision.[4]
Summary
Nepal is pursuing Social Health Insurance (SHI) as a way of mobilizing revenues to achieve Universal Health Coverage (UHC) as integrated within broader National Health Sector Strategy 2015 and Sustainable Development Goals.[1] It is, high time that policy makers decide on a few challenging but important decisions Such decisions include composition of financial contribution from poor and non-poor, benefits package, fiscal capacity to cover the benefits; SHI governance, and quality and efficiency of the delivery system while designing and implementing such a financing mechanism.[2] In this paper, our purpose is to discuss the global experiences and best practices regarding the SHI governance which can be useful in designing SHI, which is in the inception stage in Nepal. It encourages service providers to maintain quality and efficiency in services provision, which is achieved by shifting some power from the supply side to the demand side and eliminating the problems of information asymmetry between consumer
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